Kanouchi Kazunori, Narimatsu Hiroto, Shirata Toru, Morikane Keita
Division of Clinical Laboratory Yamagata University Hospital Japan.
Cancer Prevention and Control Division Kanagawa Cancer Center Research Institute Yokohama Japan.
Health Sci Rep. 2021 Mar 12;4(2):e258. doi: 10.1002/hsr2.258. eCollection 2021 Jun.
Hemophilia was diagnosed in precedence research of clot waveform analysis (CWA) using the activated partial thromboplastin time (APTT). In patients with antiphospholipid syndrome (APS), lupus anticoagulant (LA) causes an increase in APTT, suggesting that the waveform would probably be distorted. Therefore, we evaluated using clinical samples. CWA may be useful low cost for clinical detection of LA. We assessed the clinical value of CWA for detection of LA and coagulation using clinical blood samples collected from patients with a prolonged APTT.
We used patient samples inspected between April 2011 and March 2013 in Yamagata University Hospital. CWA was performed using the ACL TOP coagulation analyzer, and the associated software program was used to calculate APTT clotting endpoints. An atypical peak was defined as a derivative plot that did not conform to the normal S-shaped clot reaction curve.
In total, 162 patients, including 66 men and 96 women, with an average age of 46 years (range: 24-89 years) were included. We also collected control samples from unmatched healthy donors. All 162 patients were divided according to medication history or condition into the following five groups: heparin (n = 20), warfarin (n = 23), hepatic dysfunction (n = 13), normal (n = 20), and LA-positive antiphospholipid syndrome (APS; n = 86). Twenty healthy individuals were included as controls.Eighty patients had an atypical peak. Among all, 78 patients (90.6%) were LA-positive, and 2 patients (2.5%) were treated with warfarin. The remaining two patients had prothrombin time international normalized ratios (PT-INR) >4.0 while taking warfarin. Those who were APS LA positive with thrombosis and without thrombosis had split the reaction of clotting time, deceleration/acceleration time (D/A) ratio of 2.36 (1.99,3.24) vs 2.34 (2.04,2.86), respectively.
The significant atypical peak and D/A ratio extension may be explained by the clotting waveforms observed specifically in patients with LA-positive APS.
在先前使用活化部分凝血活酶时间（APTT）进行凝血波形分析（CWA）的研究中诊断出血友病。在抗磷脂综合征（APS）患者中，狼疮抗凝物（LA）会导致APTT延长，这表明波形可能会失真。因此，我们使用临床样本进行了评估。CWA对于LA的临床检测可能是一种低成本的有用方法。我们使用从APTT延长的患者采集的临床血样评估了CWA检测LA和凝血的临床价值。
我们使用了2011年4月至2013年3月在山形大学医院检查的患者样本。使用ACL TOP凝血分析仪进行CWA，并使用相关软件程序计算APTT凝血终点。非典型峰定义为不符合正常S形凝血反应曲线的导数图。
总共纳入了162例患者，包括66名男性和96名女性，平均年龄46岁（范围：24 - 89岁）。我们还从未匹配的健康供体采集了对照样本。所有162例患者根据用药史或病情分为以下五组：肝素组（n = 20）、华法林组（n = 23）、肝功能不全组（n = 13）、正常组（n = 20）和LA阳性抗磷脂综合征（APS；n = 86）。纳入20名健康个体作为对照。80例患者有非典型峰。其中，78例患者（90.6%）为LA阳性，2例患者（2.5%）接受华法林治疗。其余两名患者在服用华法林时凝血酶原时间国际标准化比值（PT-INR）>4.0。有血栓形成和无血栓形成的APS LA阳性患者的凝血时间反应、减速/加速时间（D/A）比值分别为2.36（1.99, 3.24）和2.34（2.04, 2.86）。
显著的非典型峰和D/A比值延长可能由LA阳性APS患者中特异性观察到的凝血波形来解释。
