狼疮抗凝物阳性患者临床数据横断面研究

Cross-sectional study on clinical data of patients with positive lupus anticoagulant

目的对狼疮抗凝物阳性患者进行临床数据横断面研究。方法采用稀释的蝰蛇毒时间(dilute Russell viper venom time,dRVVT)和硅土凝固时间(silica clot time,SCT)进行血浆狼疮抗凝物检测。对患者的年龄、性别、疾病类型、抗磷脂抗体数据和抗凝用药情况进行分析。结果LA阳性患者总体年龄为35(14~88)岁,其中男性为53(17~69)岁,女性为34(14~88)岁,两组间差异有统计学意义(U=5658.5,P=0.002)。401例患者中包括结缔组织病182例(45.4%),病理妊娠及不孕症115例(28.7%),抗磷脂综合征44例(11.0%),静脉血栓栓塞症27例(6.7%),心脑血管疾病19例(4.7%),免疫性血小板减少症或全血细胞减少14例(3.5%);在341例结缔组织病、病理妊娠及不孕症和结缔组织病患者中,男性7例,女性334例;在46例静脉血栓栓塞症和心脑血管疾病患者中,男性37例,女性9例。401例患者中,dRVVT和SCT均呈阳性者166例(41.4%),仅dRVVT阳性者149例(37.2%),仅SCT阳性者86例(21.4%);结缔组织病在上述3组每组中的所占比例率均为最高(分别为49.4%、39.6%和47.7%)。双阳性组、dRVVT(+)组和SCT(+)组的各项抗磷脂抗体阳性率间差异均无统计学意义(P均>0.05)。结论LA阳性患者之间存在明显的年龄、性别和疾病类型特征差异,检测前应充分评估患者是否符合检测适应证,且应同时检测dRVVT和SCT以避免漏诊,此外,还要充分了解患者的用药情况,必要时选择适合的采血时间进行复检。

Objective To conduct a cross-sectional study on clinical data in the patients with positive lupus anticoagulant(LA). Methods Lupus anticoagulant in plasma was tested by using the methods of diluted Russell viper venom time(dRVVT) and silica clot time(SCT). The age, gender, type of disease, data of antiphospholipid antibody and the use of anticoagulant medication were analyzed. Results The overall age of LA-positive patients was 35(14 to 88) years old, among which males were 53(17 to 69) years old and females were 34(14 to 88) years old, and the difference of age between the two groups was statistically significant(U=5 658.5, P=0.002). The enrolled 401 patients covered 182 cases(45.4%) with connective tissue disease, 115 cases(28.7%) with pathological pregnancy and infertility, 44 cases(11.0%) with antiphospholipid syndrome, 27 cases(6.7%) with venous thromboembolism, 19 cases(4.7%) with cardiovascular and cerebrovascular diseases and 14 cases(3.5%) with immune thrombocytopenia or pancytopenia. The 341 patients with connective tissue disease, pathological pregnancy and infertility and antiphospholipid syndrome were consisted of 7 males and 334 females. The 46 patients with venous thromboembolism and cardiovascular and cerebrovascular disease were consisted of 37 males and 9 females. Among all the 401 patients, 149(37.2%) cases were dRVVT positive, 86(21.4%) cases were SCT positive and 166(41.4%) cases were double positive for both dRVVT and SCT. In the each of the above three groups, the incidence of connective tissue disease was the highest, which were 49.4%, 39.6% and 47.7% in the three groups, respectively. There was no significant difference for the positive rate of antiphospholipid antibodies between dRVVT positive, SCT positive and double positive group(P>0.05). Conclusion The obvious differences for age, gender and type and characteristics of disease were found in various LA-positive patients. Before detection the patients should be adequately evaluated to be sure that they have indications for the test. dRVVT and SCT should be tested simultaneously to avoid missed diagnosis. The medication use of the patients should be fully understood. If necessary, the blood collection in appropriate time should be performed for re-examination.