Fey M F, Lang M, Furlan M, Beck E A
Central Hematology Laboratory, Inselspital, Bern, Switzerland.
Thromb Haemost. 1987 Oct 28;58(3):853-5.
Heparin therapy was monitored with the activated partial thromboplastin time (APTT) and with chromogenic substrate assays (factor Xa and factor IIa inhibition) in 100 plasma samples from 47 patients. Heparin concentrations were classified as being below, within or above a defined therapeutic range (TR; 0.2-0.55 units heparin/ml). In a first group of patients (A), all three assays allocated the plasma heparin levels to the same concentration interval with respect to the TR. The most frequent diagnoses in group A were uncomplicated arterial or venous thromboembolism, myocardial infarction with limited tissue necrosis, cardiac surgery without major complications and successfully treated infectious disease. In a second group of patients (B), the results of APTT suggested higher heparin concentrations with respect to the TR than the chromogenic assays. Predominant diagnoses were severe infectious diseases, severe liver disorders, extensive myocardial infarction and postoperative complications after cardiac surgery. The discrepancy between heparin concentrations determined by either APTT or the chromogenic substrate assays is most likely due to a non-heparin related prolongation of APTT caused by the underlying disease.
对47例患者的100份血浆样本，采用活化部分凝血活酶时间（APTT）和发色底物法（Xa因子和IIa因子抑制）监测肝素治疗情况。肝素浓度分为低于、处于或高于规定治疗范围（TR；0.2 - 0.55单位肝素/毫升）。在第一组患者（A组）中，所有三种检测方法将血浆肝素水平相对于TR分配到相同的浓度区间。A组最常见的诊断为单纯性动脉或静脉血栓栓塞、组织坏死有限的心肌梗死、无重大并发症的心脏手术以及成功治疗的传染病。在第二组患者（B组）中，APTT结果显示相对于TR而言，肝素浓度高于发色底物法检测结果。主要诊断为严重传染病、严重肝脏疾病、广泛心肌梗死以及心脏手术后的术后并发症。APTT或发色底物法所测定的肝素浓度之间的差异很可能是由于基础疾病导致的与肝素无关的APTT延长所致。
