活化血浆凝固时间对免疫性血小板减少症患者出血的风险评估

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摘要目的：探讨活化血浆凝固时间（APCT）对免疫性血小板减少症（ITP）患者出血的风险评估。方法：2008年4月至2013年7月在我院血液科住院的ITP患者共128名。抽取患者静脉血，测定血小板计数和APCT。将患者分为血小板计数＜30×109/L组和血小板计数（30～79）×109/L组。将APCT与Khellaf出血评分结果进行相关性分析，探讨APCT预示ITP患者血小板减少所致出血的敏感性、特异性、假阳性率及其与Khellaf出血评分的相关性。结果：APCT≥90 s为界点值，对预示血小板减少所致出血的敏感性为100%，特异性为91.3%，假阳性率为8.69%，假阴性率为0%。在血小板计数＜30×109/L组中，APCT与Khellaf出血评分数值呈直线型正相关（r=0.968，P=0.013）。在血小板计数（30～79×）109/L组中，APCT的变化与Khellaf出血评分亦具有正相关性（r=0.764，P=0.01）。结论：APCT具有良好的敏感性和特异性，是评估ITP患者出血风险的良好指标。

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关键词 ：免疫性血小板减少症, 活化血浆凝固时间, 血小板计数, Khellaf出血评分系统

Abstract：Objective: To investigate the value of activated plasma clotting time (APCT) for assessing the bleeding diathesis of immune thrombocytopenia. Methods: There were one hundred and twenty-eight patients of diopathic immune thrombocytopenia. Taking the patient抯 venous blood, the patient抯 blood platelet count and activated plasma clotting time were determined. The patients were devided into two groups by platelet count, one group抯 platelet count was lower than 30×109/L, and the other group抯 platelet count was 30×109/L～79×109/L.Acorrding to the test, we could get APCT. By analyzing APCT and Khellaf bleeding score, we could receive that APCT and Khellaf bleeding score results had linear correlation. Results: We set APCT critical point was high than ninety seconds. The sensibility to assess the ITP patient抯 bleeding was 100%, the specificity is 91.3% and the false positive rate 8.69%. In the group抯 platelet count was lower than <30×109/L, we could receive that APCT and Khellaf bleeding score results had linear positive correlation, P=0.013, r=0.968. In the group抯 platelet count was about 30×109/L～79×109/L, we could receive that APCT and Khellaf bleeding score results had correlation,P=0.01, r=0.764. Conclusion: APCT has a good sensibility and specificity. It is a good predictive index to assessing the bleeding of ITP.q

Key words： immune thrombocytopenia activated plasma clotting time blood platelet count Khellaf bleeding score system

收稿日期: 2013-08-26

基金资助:温州市科技局科研基金资助项目（Y20080210）。

作者简介: 何牧卿（1979-），女，浙江金华人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2014/V44/I3/197

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