摘要目的 了解住院患者肝素诱导的血小板减少症(HIT)发病率和HIT抗体阳性率及相关临床因素.方法 选取应用肝素制剂的患者197例(男120例、女77例),进行4Ts评分(Pretest Clinical Scoring System)及应用酶联免疫吸附试验(ELISA)检测HIT抗体,并按4Ts评分及病种分组、分别统计HIT发病率及HIT抗体阳性率.结果 HIT总发病率为3.0％ (6/197)；HIT抗体总阳性率为12.2％ (24/197),抗体阳性率在4Ts评分低、中、高可能性组分别为10.1％ (18/178)、7.7％(1/13)、83.3％ (5/6).HIT抗体阳性率和抗体检测平均值,在高可能性组与低、中可能性组之间差异均有统计学意义(P值均=0.000).HIT发病率及HIT抗体阳性率均为外科高于内科(5.8％比0.9％,P =0.047；19.8％比6.3％,P=0.004).结论 肝素制剂应用人群中HIT的发病率和HIT抗体阳性率不低,且均与病种有关.HIT抗体检测在4Ts评分高可能性患者中的临床应用价值更大.

abstractsObjectives To investigate the incidence of the heparin-induced thrombocytopenia (HIT) and positivity of anti-heparin/platelet factor 4 complex antibody (HIT-antibody) in inpatients treated with heparin preparations.Methods A total of 197 consecutive patients,including 120 men and 77 women,who were treated with unfractioned heparin (UFH) or low molecular weight heparin (LMWH),were enrolled in this study.HIT-antibody was detected by enzyme-linked immunosorbent assay (ELISA).All patients were classified into subgroups based on "4Ts" (Pretest Clinical Scoring System) and types of underlying disorders.The incidence of HIT and positivity of HIT-antibody among different groups were analyzed.Results The overall incidence of HIT was 3.0％ (6/197),and the positivity of HIT antibody was 12.2％ (24/197).The positivity of HIT-antibody was 10.1％ (18/178),7.7％ (1/13) and 83.3％(5/6) in low,moderate and high HIT probability group respectively.There were significant differences of HIT positivity and mean level of HIT-antibody between the high HIT probability group and the low or moderate HIT probability group (P =0.000).Both the incidence of HIT and positivity of HIT-antibody were higher in surgical patients than in medical patients (5.8％ vs 0.9％,P =0.047 and 19.8％ vs 6.3％,P =0.004).Conclusions The incidence of HIT and positivity of HIT-antibody were 3.0％ and 12.2％ respectively,both of which were related with the types of disorders.Detection of HIT-antibody has a better applicable value in patients with high HIT probability.