稀释蝰蛇毒时间试验与混合试验在狼疮抗凝物检测中的相关性研究

Research on correlation between results of diluted Russell viper venom time(dRVVT) test and mixing test in detection of lupus anticoagulant

目的:探究狼疮抗凝物检测中稀释蝰蛇毒时间(diluted Russell viper venom time, d RVVT)法与混合试验(Rosner指数)检测结果间的相关性及方法学特点。方法:2015年9月至2019年9月期间,收集在上海交通大学医学院附属瑞金医院就诊的31例凝血功能异常、狼疮抗凝物阳性患者的临床资料,比较d RVVT标准化比值与混合试验(Rosner指数的R1、R2)检测结果间的相关性,进而探究2种方法间的异同。结果:从31例患者dRVVT标准化比值与病人血浆(病浆)活化部分凝血活酶时间(activated partial thromboplastin time,APTT)值与混合试验的R1、R2的散点图可以看出,d RVVT标准化比值分别与病浆APTT值、R1及R2之间具有较好的相关性。进一步应用Pearson相关性分析得出,dRVVT标准化比值与混合试验检测结果显著相关(相关系数r值为0.54~0.62,P<0.05)。结论:基于共同凝血途径d RVVT法的确证试验与混合试验(基于内源性及共同凝血途径)结果间具有显著相关性,但并非严格的线性相关。2种检测方法在狼疮抗凝物检测中并不可完全替代,因此仍建议将二者相结合进行分析,从而提高狼疮抗凝物的检出率,降低误诊率和漏诊率。

Objective: To investigate the correlation between diluted Russell viper venom time(dRVVT) test and mixing test in detection of lupus anticoagulant(LA) and their methodological characteristics. Methods: The clinical data of 31 patients with coagulation dysfunction and positive LA were collected from Ruijin Hospital, Shanghai Jiao Tong Uni-versity from September 2015 to September 2019. The correlation between the results of standardized ratio of dRVVT and mixing test(Rosner index) was analyzed, and the similarities and differences of the two methods were explored. Results:The scatter diagram revealed that the standardized ratio of d RVVT had a close correlation with the activated partial throm-boplastin time(APTT), R1 and R2. Pearson correlation analysis showed that there was a significant correlation between the standardized ratio of d RVVT and the results of mixing test(r: 0.54-0.62). Conclusions: Although there is a significant correlation between d RVVT based on common pathway and the mixing test based on both intrinsic pathway and common pathway, yet it is not a strict linear correlation. The two methods cannot be completely replaced by each other in the de-tection of lupus anticoagulant, and it is suggested that the combined use of the two methods can improve the detection rate of lupus anticoagulant and reduce the misdiagnosis and missed diagnosis.