抗血小板因子 4 抗体和血小板活化试验在疫苗诱导免疫性血栓性血小板减少症患者中的作用：实验室诊断比较及文献复习简要报告。
The role of anti-platelet factor 4 antibodies and platelet activation tests in patients with vaccine-induced immune thrombotic thrombocytopenia: Brief report on a comparison of the laboratory diagnosis and literature review.
机构信息
Department of Life Sciences, National Central University, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan; Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Biomedical Sciences and Engineering, Institute of Systems Biology and Bioinformatics, National Central University, Taoyuan, Taiwan.
出版信息
Clin Chim Acta. 2022 Apr 1;529:42-45. doi: 10.1016/j.cca.2022.02.003. Epub 2022 Feb 12.
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel human pathogen causing coronavirus disease 2019 (COVID-19). Rare cases of COVID-19 vaccine-induced immune thrombotic thrombocytopenia (VITT) after the ChAdOx1 nCoV-19 (AstraZeneca) vaccination have been reported. We performed a test for anti-heparin/ platelet factor 4 (PF4) antibodies and functional assay using flow cytometry.
METHOD
A healthy woman presented to the emergency department with chest pain, headache, and abdominal pain after the first vaccination with AstraZeneca. Polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. Chest computed tomography (CT) showed pulmonary artery embolism and brain magnetic resonance imaging (MRI) revealed cerebral sinus-venous thrombosis. Abdominal CT demonstrated the thrombosis with occlusion in her right hepatic vein. Laboratory studies revealed decreased platelet counts, and high D-dimer level. Finally, laboratory results indicated high PF4 antibodies level high and a positive platelet activation test, confirming the diagnosis of VITT.
RESULTS
Treatments including intravenous immunoglobulin, methylprednisolone and direct oral anticoagulant were administered. The results of a follow-up platelet count and D-dimer were normal. In addition, the titer of PF4 antibodies (optical density: 0.425; normal ≤ 0.4, enzyme-linked immunosorbent assay) fell. After a 3-month follow-up, her general condition improved gradually.
CONCLUSIONS
The use of COVID-19 vaccines to prevent SARS-CoV-2 infections and complications is considered the most practicable policy for controlling the COVID-19 pandemic and is being forcefully pursued in the global area. Appropriate laboratory diagnosis facilitates the accurate and rapid diagnosis. Early recognizing and appropriate strategies for VITT are required and can provide these patients with more favorable patient outcomes. This report also elected to make comparisons of clinical manifestation, laboratory diagnosis, and management in patients with VITT.
背景
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是一种新型人类病原体，可引起 2019 年冠状病毒病（COVID-19）。在接种 ChAdOx1 nCoV-19（阿斯利康）疫苗后，有罕见的 COVID-19 疫苗诱导的免疫性血栓性血小板减少症（VITT）病例报告。我们使用流式细胞术进行了抗肝素/血小板因子 4（PF4）抗体检测和功能检测。
方法
一名健康女性在接种阿斯利康第一剂疫苗后，因胸痛、头痛和腹痛就诊于急诊科。SARS-CoV-2 的聚合酶链反应（PCR）检测为阴性。胸部计算机断层扫描（CT）显示肺动脉栓塞，脑磁共振成像（MRI）显示脑窦-静脉血栓形成。腹部 CT 显示右肝静脉血栓形成伴闭塞。实验室研究显示血小板计数降低，D-二聚体水平升高。最后，实验室结果表明 PF4 抗体水平升高，血小板激活试验阳性，确诊为 VITT。
结果
给予静脉注射免疫球蛋白、甲基强的松龙和直接口服抗凝剂治疗。血小板计数和 D-二聚体的随访结果正常。此外，PF4 抗体滴度（光密度：0.425；正常≤0.4，酶联免疫吸附试验）下降。经过 3 个月的随访，她的一般情况逐渐改善。
结论
使用 COVID-19 疫苗预防 SARS-CoV-2 感染和并发症被认为是控制 COVID-19 大流行的最实用策略，正在全球范围内大力推行。适当的实验室诊断有助于准确快速诊断。需要早期识别和适当的 VITT 策略，可以为这些患者提供更有利的预后。本报告还选择对 VITT 患者的临床表现、实验室诊断和治疗进行比较。
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