摘要
目的分析肝素诱导的血小板减少症(HIT)的临床特征及预后。方法抽取2016年1月至2023年4月于郑州大学第一附属医院应用肝素类药物进行抗凝治疗后新发的HIT患者42例,收集其一般资料、临床表现及预后指标等临床资料,分析HIT的病因、临床特征及预后。结果42例HIT患者中,I型HIT 32例,Ⅱ型HIT 10例;主要原发病为冠心病32例(76.19%);经皮冠动脉介入治疗术后发生HIT 28例(66.67%),连续肾脏替代治疗术后发生HIT 3例(7.14%);导致HIT的肝素类药物主要为肝素钠29例(69.05%)和低分子肝素6例(14.29%)。接触肝素类药物后,I型HIT出现血小板下降的时间为1(1,2)d,早于Ⅱ型HIT的6(5,10)d,P<0.001。I型HIT的血小板减少评分系统(4Ts)评分[4(4,5)分]低于Ⅱ型HIT[6(5,7)分],P<0.001。治疗后,I型HIT患者血小板恢复正常时间(7.09 d)与Ⅱ型HIT(10.20 d)比较差异未见统计学意义(P=0.120)。I型HIT患者中无血栓事件发生,Ⅱ型HIT患者中有4例出现血栓,Ⅱ型比I型预后差(P=0.002)。结论在应用肝素类药物后,I型HIT较Ⅱ型HIT发生迅速、4Ts评分更低,I型及Ⅱ型HIT及时治疗后血小板计数均能恢复正常,但Ⅱ型HIT发生血栓风险高于I型。
Objective To analyze the clinical features and prognosis of heparin-induced thrombocytopenia(HIT).Methods A total of 42 patients with HIT after anticoagulation therapy with heparin in the First Affiliated Hospital of Zhengzhou University from January 2016 to April 2023 were selected.And the general data,clinical manifestations,prognosis indicators of the selected patients were collected to analyze the etiology,clinical features and prognosis of HIT.Results Among the 42 HIT patients,there were 32 cases of type I HIT and 10 cases of type II HIT.Coronary heart disease was the most common primary disease in the 42 HIT patients(32 cases,76.19%);28 cases(66.67%)of HIT occurred after percutaneous coronary intervention,and 3 cases(7.14%)of HIT occurred after continuous renal replacement therapy.The main heparin drugs causing HIT were heparin sodium(29 cases,69.05%)and low molecular weight heparin(6 cases,14.29%).After application of heparin drugs,the median days for platelet decrease in type I HIT was 1(1,2)days,which was earlier than the median days,6(5,10)days,in type II HIT(P<0.001).The HIT 4T’s score of type I HIT was 4(4,5),lower than the 6(5,7)of type II HIT(P<0.001).After treatment,there was no statistically significant difference in platelet counts recovery time between type I HIT patients(7.09 days)and type II HIT patients(10.20 days),P=0.120.There was no thrombosis in patients with type I HIT,while 4 patients with typeⅡHIT had thrombosis.The prognosis of type II HIT was worse than that of type I HIT(P=0.002).Conclusions After the use of heparin,type I HIT develops more rapidly and has lower HIT 4T’s score,compared with type II HIT.The platelet counts of patients with type I and type II HIT could return to normal after timely treatment.However,the risk of thrombosis in patients with typeⅡHIT is higher than that in patients with type I HIT.
作者
韩冰
王岩
杜佳欣
杜丽娟
孙同文
Han Bing;Wang Yan;Du Jiaxin;Du Lijuan;Sun Tongwen(Integrated Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《中国实用医刊》
2023年第16期5-8,共4页
Chinese Journal of Practical Medicine
作者简介
通信作者:孙同文,Email:suntongwen@163.com。
