抗磷脂抗体、APTT纠正试验联合检测在儿童APTT单独延长中的临床应用

The Clinical Application of Combined Detection of Antiphospholipid Antibody and PTT Correction Test in APTT Alone Extension in Children

目的研究儿童(1~14岁)APTT单独延长,联合抗磷脂抗体检测以及APTT纠正试验来明确APTT单独延长的原因,以期协助临床医生实施精准治疗方案,避免误诊误治情况的发生。方法收集2019年6月至2022年5月单独APTT延长共97例儿童,对其进行抗磷脂抗体、APTT纠正试验检测,并结合患者临床症状和最终诊断,将其分为4组即感染组61例,凝血因子活性偏低组9例,免疫性疾病组8例,不明原因组19例。对各组检测结果综合分析统计,以评估APTT单独延长原因及对相关自身免疫性疾病的辅助诊断。结果使用Bonferroni法对4组两两进行比较,免疫性疾病组与凝血因子活性偏低组、感染组、不明原因组在APTT延长数值上差异均有统计学意义。感染组61例中,APTT纠正实验不能纠正的56例(91.8%),处于灰区为5例(8.2%);狼疮抗凝物(LA)为阳性55例(90.16%),抗心磷脂抗体(aCL)阳性为5例(8.20%),抗β2 GPI阳性为4例(6.56%)。结论儿童APTT单独延长时,联合抗磷脂抗体检测、APTT纠正试验、凝血因子检测(必要时)可及时找到APTT单独延长的原因,且绝大多数都是因感染引起体内一过性抗磷脂抗体(尤其是狼疮抗凝物)增高引起的,通常无需特殊治疗和过度检查;以儿童APTT单独延长为基点,联合抗磷脂抗体检测在自身免疫性疾病的诊断中具有一定的临床应用价值。

Objective To study the single prolongation of APTT in children(1-14 years old),and to clarify the potential cause of single prolongation of APTT in combination with antiphospholipid antibody detection and APTT correction experiment,so as to assist clinicians to implement precise treatment plan and avoid misdiagnosis and mistreatment.Methods A total of 97 children with prolonged APTT alone from June,2019 to May,2022 were collected for antiphospholipid antibody and APTT correction test.Combined with clinical symptoms and final diagnosis,these children were divided into four groups:61 cases in the infection group,9 cases in the low activity of coagulation factor group,8 cases in the immune disease group,and 19 cases in the unknown group.The results of each group were comprehensively analyzed with statistical methods to evaluate the potential cause of APTT alone prolongation and its auxiliary diagnosis for related autoimmune diseases.Results Bonferroni method was used for pairwise comparison among the four groups,and P value less than 0.05 was used to indicate statistically significant difference.There were statistically significant differences in APTT elongation between the immune disease group,the low coagulation factor activity group,the infection group and the unknown cause group,and the APTT elongation degree was the highest.In 61 cases of infection group,56 cases(91.8%)could not be corrected by APTT correction test,and 5 cases(8.2%)were in the gray area.Lupus anticoagulant(LA)was positive in 55 cases(90.16%),anticardiolipin antibody(aCL)positive in 5 cases(8.20%),and anti-β2GPI positive in 4 cases(6.56%).Conclusion When APTT is prolonged alone in children,the combination of antiphospholipid antibody detection,APTT correction test,and coagulation factor detection(if necessary)can timely identify the cause of APTT prolonged alone,most of them are caused by the increase of transient antiphospholipid antibody(especially lupus anticoagulant)derived from infections,without treatment or excessive examination;Taking APTT prolongation alone as the base point,combined with anti-phospholipid antibody detection has certain clinical application value in the diagnosis of autoimmune diseases.