Wada Hideo, Ichikawa Yuhuko, Ezaki Minoru, Matsumoto Takeshi, Yamashita Yoshiki, Shiraki Katsuya, Shimaoka Motomu, Shimpo Hideto
Department of General and Laboratory Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan.
Department of Central Laboratory, Mie Prefectural General Medical Center, Yokkaichi 510-0885, Japan.
J Clin Med. 2021 Oct 21;10(21):4840. doi: 10.3390/jcm10214840.
Although thrombin burst has attracted attention as a physiological coagulation mechanism, clinical evidence from a routine assay for it is scarce. This mechanism was therefore evaluated by a clot waveform analysis (CWA) to assess the thrombin time (TT).
The TT with a low concentration of thrombin was evaluated using a CWA. We evaluated the CWA-TT of plasma deficient in various clotting factors, calibration plasma, platelet-poor plasma (PPP), and platelet-rich plasma (PRP) obtained from healthy volunteers, patients with thrombocytopenia, and patients with malignant disease.
Although the TT-CWA of calibration plasma was able to be evaluated with 0.01 IU/mL of thrombin, that of FVIII-deficient plasma could not be evaluated. The peak time of CWA-TT was significantly longer, and the peak height significantly lower, in various deficient plasma, especially in FVIII-deficient plasma compared to calibration plasma. The second peak of the first derivative (1st DP-2) was detected in PPP from healthy volunteers, and was shorter and higher in PRP than in PPP. The 1st DP-2 was not detected in PPP from patients with thrombocytopenia, and the 1st DP-2 in PRP was significantly lower in patients with thrombocytopenia and significantly higher in patients with malignant disease than in healthy volunteers.
The CWA-TT became abnormal in plasma deficient in various clotting factors, and was significantly affected by platelets, suggesting that the CWA-TT may be a useful test for hemostatic abnormalities.
尽管凝血酶爆发作为一种生理性凝血机制已引起关注，但常规检测该机制的临床证据却很匮乏。因此，本研究通过凝血块波形分析（CWA）来评估凝血酶时间（TT），以对这一机制进行评价。
使用CWA评估低浓度凝血酶时的TT。我们对来自健康志愿者、血小板减少症患者和恶性疾病患者的缺乏各种凝血因子的血浆、校准血浆、乏血小板血浆（PPP）和富血小板血浆（PRP）的CWA-TT进行了评估。
校准血浆的TT-CWA能够用0.01 IU/mL的凝血酶进行评估，但FVIII缺乏血浆的TT-CWA无法评估。与校准血浆相比，各种缺乏血浆中CWA-TT的峰值时间显著延长，峰值高度显著降低，尤其是FVIII缺乏血浆。在健康志愿者的PPP中检测到一阶导数的第二个峰值（1st DP-2），PRP中的1st DP-2比PPP中的更短且更高。血小板减少症患者的PPP中未检测到1st DP-2，血小板减少症患者PRP中的1st DP-2显著低于健康志愿者，而恶性疾病患者PRP中的1st DP-2显著高于健康志愿者。
CWA-TT在缺乏各种凝血因子的血浆中出现异常，且受血小板的显著影响，提示CWA-TT可能是一种用于检测止血异常的有用试验。
