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目的:探讨HIT抗体在HIT中的诊断价值。方法:采用酶联免疫吸附法(ELISA)检测HIT抗体,进一步观测应用肝素的患者HIT抗体的产生情况,临床观察血管外科应用普通肝素治疗49名下肢动脉硬化性闭塞症(ASO)患者。采用自身对照,实验组为应用肝素治疗后的49名患者血清,对照组为应用肝素治疗前该49名患者血清,分别进行HIT抗体检测。结果:实验组中HIT抗体阳性例数为21例,对照组为3例。实验组与对照组差异有统计学意义。实验组中9例患者血小板下降(血小板下降范围23.3%～63.8%),其中8例HIT抗体阳性,1例抗体阴性。该9例患者后经功能性检查确诊为HIT患者。其中2例患者血小板下降早于HIT抗体的出现,其余6例患者血小板下降时间比HIT抗体出现时间晚。HIT发病率为18.37%。结论:HIT抗体检测的实验敏感性较高,且不涉及放射性,操作简单,快捷。与临床表现、血小板计数检测结合可对应用肝素的下肢动脉硬化性闭塞症患者进行初筛。
Objective: To investigate the diagnostic value of HIT antibody in HIT. Methods: HIT antibody was detected by enzyme-linked immunosorbent assay (ELISA). HIT antibody production in patients with heparin was further observed. Forty-five patients with lower extremity arteriosclerotic occlusive disease (ASO) were treated with unfractionated heparin in vascular surgery. Using self-control, the experimental group was treated with heparin after treatment of 49 patients sera, the control group for the application of heparin before treatment of the 49 patients serum HIT antibody were detected. Results: In the experimental group, the positive number of HIT antibody was 21 cases and the control group was 3 cases. The difference between the experimental group and the control group was statistically significant. In the experimental group, 9 patients had thrombocytopenia (23.3% ~ 63.8% of the platelets decreased), of which 8 were positive for HIT antibody and 1 was negative for antibody. The 9 patients were diagnosed as HIT after functional examination. Two of the patients had a decrease in platelet earlier than the appearance of HIT antibody, and the remaining 6 patients had a later platelet decline than HIT antibody. The incidence of HIT was 18.37%. Conclusion: The sensitivity of HIT antibody test is high, and it does not involve radioactivity, so it is simple and quick to operate. And clinical manifestations, combined with platelet count detection can be applied to heparin in patients with lower extremity arteriosclerosis obliterans screening.