测定凝血4项检测结果异常的影响因素分析

Influence Factors About the Abnormal Examination Results of Four Coagulation Function Indexes

目的 探讨凝血4项检测结果异常的影响因素。方法 选取2021年5月至2022年10月于南阳市中心医院行凝血项目检验的55份血液标本,分别在不同标本采集量、不同条件下制备、常温下储存时间、离心时间及溶血与未溶血试验下检测凝血四项[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),凝血酶时间(TT)、纤维蛋白原(Fib)],总结上述各种不同处理方式对检验结果的影响,并评估凝血4项检测结果异常的主要影响因素。结果 采血量<2.0 mL和> 2.0 mL的凝血四项结果均与合格标本产生明显差异,其中PT、APTT、TT均长于合格标本,而FIB小于合格标本,差异有统计学意义(P<0.05);不同离心时间下,离心时间5 min的PT、APTT值最短,差异有统计学意义(P<0.05);选择3 000 r/min,15 min和4 000 r/min,15 min制备乏血小板血浆检测凝血4项差异无统计学意义(P>0.05)。常温下储存时间4 h的APTT明显长于放置2 h的标本,TT值短于放置2 h的标本,差异有统计学意义(P<0.05),其余指标对比差异无统计学意义(P>0.05);溶血标本的PTA、PTT均明显短于未溶血标本,TT长于未溶血标本,差异有统计学意义(P<0.05)。但标本是否溶血未对FIB造成影响,指标对比差异无统计学意义(P>0.05)。经Logistic回归分析结果显示,不同标本采集量、常温下储存时间、离心时间及标本溶血与未溶血试验均是影响凝血项目检验的相关因素,差异有统计学意义(OR均> 1,P<0.05)。结论 凝血项目检验结果的准确性和可靠性异常会受标本采集量、常温时间储存过长、离心时间及溶血等因素影响,故在临床检验中应严格控制标本采集至运输的整个过程,高度重视标本分析前的质量控制工作,以增加检验准确性,为临床诊断提供正确依据。

Objective To discuss the influence factors about the abnormal examination results of four coagulation function indexes.Methods A total of 55 blood samples were selected for the coagulation program in Nanyang Central Hospital from May 2021 to October 2022.The four coagulation function indexes like prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(Fib)were measured based on the different sample collection volumes,different preparation conditions,normal temperature storage time,centrifugation time,hemolysis test and non-hemolysis test.Through the different processing methods,the major influence factors about the abnormal examination results of four coagulation function indexes were concluded and evaluated.Results The four results of blood collection with<2.0 mL and>2.0 mL were significantly different from the qualified samples;PT,APTT and TT in blood samples<2.0 mL/>2.0 mL were longer than qualified samples;FIB contents were lower than qualified samples,with significant differences(P<0.05);Under the different centrifugation time,the PT and APTT values of 5 min centrifugation time are the shortest,with significant differences(P<0.05);There were no significant differences about the four coagulation function indexes between samples with sample preparations at 3000 r/min,15 min and 4000 r/min,15 min(P>0.05);In the normal temperature,APTT at 4 h of storage time was longer than that at 2 h of storage time;TT was shorter than that at 2 h of storage time,with significant differences(P<0.05);At 2 h and 4 h of storage time,the other indexes were not significant different(P>0.05);APTT and PT for hemolysis samples were shorter than non-hemolysis samples;TT was longer than non-hemolysis samples,with significant differences(P<0.05);FIB contents between hemolysis and non-hemolysis samples were not significantly different(P>0.05).Logistic regression equation indicated that the major influence factors of four coagulation function examination indexes were the different sample collection volumes,normal temperature storage time,centrifugation time,hemolysis test and non-hemolysis test,with significant differences(OR>1,P<0.05).Conclusion The examination accuracy and reliability of coagulation function indexes are mainly affected by the sample collection volumes,extended normal temperature storage time,centrifugation time and hemolysis test.Therefore,the whole process of the specimen collection and transportation should be strictly controlled,and great attention should be paid to the quality control before the specimen analysis,so as to increase the accuracy of the testing and provide a correct basis for clinical diagnosis.