摘要目的 观察应用肝素治疗患者肝素诱导的血小板减少症(HIT)发病情况,探索血小板计数监测HIT的可行性及HIT抗体检测对HIT诊断的意义.方法 对在血管外科应用普通肝素(UFH)治疗的145例患者进行临床观察,于应用UFH治疗前及治疗后进行血小板计数、HIT抗体ELISA检测及肝素诱导的血小板聚集试验(HIPA)等实验室检测.结果 145例患者中血小板减少40例(27.6%),HIT抗体阳性59例(40.7%),HIPA阳性26例(17.9%),诊断HIT 24例(16.5%),其中发生HIT并血栓形成综合征(HITTS)5例(发病率3.4%,占HIT患者的20.8%).多数HIT患者(15例,62.5%)血小板减少与HIT抗体阳性、HIPA阳性同时发生.24例HIT患者的血小板计数均在停用UFH后3～6 d恢复到正常或达到用UFH前水平.结论 通过动态监测血小板计数、联合HIT抗体ELISA法检测及HIPA,可以早期诊断HIT,及时停用UFH,换用抗凝剂,HITTS的发生率有望进一步下降,减少致残、死亡的发生.

abstractsObjective To observe the incidence of heparin-induced thrombocytopenia (HIT) in patients received unfractionated heparin ( UFH ) treatment, and explore the feasibility of monitoring HIT by platelet counts, as well as the significance of HIT-antibody test in HIT diagnosis. Methods 145 patients received UFH treatment in Vascular Surgery Department were studied. Before and after the UFH treatment,platelet counts, HIT-antibody ELISA test and heparin-induced platelet aggregation (HIPA) were tested.Results Among the 145 patients, thrombocytopenia occurred in 40 ( 27.6% ) cases, HIT-antibody ELISA test positive in 59(40.7% ) cases, HIPA test positive in 26( 17.9% ) cases. The HIT was diagnosed in 24 (16.5%) cases, and heparin-induced thrombocytopenia and thrombosis (HITTS) occurred in 5( 3.4% in all cases, and 20.8% in HIT patients). In HIT patients, 15 patients (62.5%) were thrombocytopenia, HITantibody positive and HIPA test positive. Platelet counts in all of the 24 patients recovered to normal or level before UFH treatment in 3 -6 days after heparin withdrawal therapy. Conclusion HIT can be early diagnosed by monitoring platelet counts, HIT-antibody ELISA test and HIPA test. Withdrawal of heparin therapy in time and use of alternative anticoagulant, HITTS rate might be expected to decline further.