床边检查仪与自动化凝血仪在肝素治疗时凝血功能检验的差异

Difference in examination of coagulation function in heparin anticoagulant therapy between point of care tests and automatic coagulation analyzer

目的确定床边检查(POCT)仪与全自动凝血仪在肝素治疗时凝血常规检验和监测肝素治疗中的差异。方法以接受肝素抗凝治疗的老年心血管病患者为研究对象,分别使用Hemachron JrⅡ和 CG02两种 POCT 仪器与全自动凝血仪 STA-R 对比检测血浆凝血酶原时间(PT),国际标准化比值(INR),活化部分凝血活酶时间(APTT)和纤维蛋白原含量(Fbg),并将不同肝素水平的血浆凝血指标进行统计分析。结果干化学法床边检查仪和自动化凝血仪对凝血参数 PT、INR、APTT、Fbg 的检测具有较好的相关性(r 分别为0.945、0.966、0.662和0,977,均 P<0.05);监测肝素治疗时,Hemachron JrⅡ与自动化凝血仪检测 APTT 结果差异有统计学意义(P<0.01)。结论干化学法床边设备不适于与自动化凝血仪同时报告凝血检验结果。

Objective To investigate the difference in coagulation screening in heparin anticoagulant therapy between dry-chemistry point of care tests （POCT） and automatic analyzer. Methods Blood samples were collected from 44 patients with myocardial infarction or intracranial hemorrhage, 34 males aged 78 ± 10 and 10 females aged 73 ± 8, to undergo examination of prothrombin time （ PT ）, international normalized ratio （INR）, activated partial thromboplastin time（ APTT）, and fibrinogen （Fbg） by dry-chemistry methods with coagulation analyzers of the models CG02 and Hemachron Jr Ⅱ. The levels of APTT of 30 patients were measured by the bedside with analyzers model Hemachron Jr Ⅱ, after their anticoagulation samples underwent measurement of the plasma heparin activity with ACL Advance automatic coagulation analyzer; the AFIT was determined with STA-R. Results The correlation coefficients of PT, INR, APTT, and Fbg between the CG02 and STA-R results were 0. 945,0. 966, 0. 662, and 0. 977 respectively （all P 〈0. 05）. However, t test showed that the levels of PT and INR between these 2 groups were not significant, and the differences in the levels of APTT and Fbg were significant（ both P 〈 0. 05 ）. ACL Advance analyzer showed that the heparin activities of 30 samples were 172 ～ 1465 U/L, and the APTT values measured by Hemachron Jr II and STA-R were 87 s ±32 s and 90 s ±46 s （P 〈0. 01 ）. Conclusion Dry-chemistry POCT is not suitable to report the results of the same patient simultaneously with the automatic analyzer.