应用血小板图和快速血栓弹力图评价体外凝血功能

Evaluation of coagulation in vitro with platelet mapping and rapid TEGTM on thrombelastography

自的 用血小板膜糖蛋白GPⅡb/Ⅲa抑制剂阿昔单抗在体外抑制全血中血小板来观察血小板图（PlateletMapping（R））技术的方法学可靠性,并对血小板图和凝血激活检测试剂盒（Rapid TEGTM,快速血栓弹力图）两种方法进行评估.方法 根据临床性能评价的要求,将不同浓度的阿昔单抗与健康志愿者全血混合后进行血小板图测试,并用Rapid TEG试剂盒测定肝素抗凝血的活化凝血时间（TEG（R） ACT）等参数,计算两种方法的线性、重复性和有效性.结果 随着阿昔单抗浓度的升高,除纤维蛋白原以外各激活方式凝集曲线的MA都有明显的线性减低;在（1～4）×10-2 mg阿昔单抗作用下,不同通道和系统的血小板抑制率重复性良好（CV＜10%）;加入阿昔单抗后,AA激活途径的血小板抑制率由28.0%±2.8%升至63.4%±0.0%（t=21.9,P＜0.01）;ADP激活途径血小板抑制率由35.9%±0.56%升至91.4%±1.1%（t=58.9,P＜0.01）.TEG（R） ACT与肝素呈现明显的剂量线性关系;快速血栓弹力图检测参数除R以外,K、α、MA和TEG（R）ACT的测量重复性良好（CV＜5%）.结论 血小板图能够灵敏地反映出血小板所受抑制程度的不同,具有良好的测量精密度和剂量效应关系.Rapid TEG在以TEG（R） ACT监测肝素浓度的同时,还提供了对总体凝血功能的分析.

Objective To evaluate performance of PlateletMapping（R） and RapidTEGTM based on thrombelastography by blocking platelet function with Reopro.Methods PlateletMapping was carried out with whole blood from healthy volunteers mixed with Reopro in vitro in a serial of titration.TEG（R） ACT of heparinized blood was tested with Rapid TEG kits.Linearity, repeatability and validity were calculated for two methods.Results MA activated by Kaolin, AA and ADP decreased with the increase of the concentration of Reopro. Inhibition rates （%）for AA and ADP induced aggregation were repeatable in channels and systems.At the Reopro levels of （1-4） × 10-2 mg, inhibition rate increased statistically（ AA：27.99% ± 2.8% vs 63.37% ± 0.0% ,t = 21.9, P 〈 0.01;ADP： 35.9% ± 0.56% vs 91.42% ± 1.14%,t=58.9,P 〈 0.01 ） after addition of Reopro.Dose-dependent effect relationship could be seen between TEG（R） ACT and heparin;In Rapid TEG assay, measurement repeatability of K, α angle, MA and TEG（R）ACT were all good （ CV 〈 5% ） except for R.Conclusions PlateletMapping（R） is sensitive to the inhibition of platelet function with good precision with dose-dependent effect.Moreover, Rapid TEG provides analysis of the overall coagulation function besides monitoring heparin therapy. Keywords：Thrombelastograghy;Platelet function tests;Platelet aggregation;Antibodies,monoclonal;Immunoglobulin fab fragments;Heparin