快速微粒凝胶免疫测定法与酶联免疫吸附测定法检测HIT抗体的临床应用比较

目的比较快速微粒免疫凝胶法（PaGIA）和酶联免疫吸附测定法（ELISA）检测HIT抗体在诊断肝素诱导的血小板减少症（HIT）中的应用。方法选取应用肝素制剂患者197例,男性120例、女性77例,根据4 Ts评分系统临床诊断HIT,所有患者均应用ELISA法进行HIT抗体检测,对ELISA法检测阳性及出现血小板减少的患者再次应用PaGIA法进行检测,并对两次HIT抗体检测结果进行比较。结果 4 Ts评分临床诊断HIT患者6例,两种检测方法分别检测出5例抗体阳性。24例ELISA法检测阳性患者中的19例非HIT患者,应用PaGIA法再次检测仅有3例阳性。结论4 Ts评分系统仍是目前临床诊断HIT的重要依据,联合HIT抗体检测可提高确诊和除外HIT诊断的准确性。PaGIA法检测HIT抗体与临床符合度更高,优于ELISA法。     

酶联免疫吸附法检测抗肝素/血小板因子4复合物抗体的临床意义

目的：评价酶联免疫吸附法（ELISA）检测抗肝素/血小板因子4复合物抗体对临床诊断肝素诱导的血小板减少症（HIT）的敏感性及特异性。方法：选取应用肝素制剂患者197例（男120例、女77例）,ELISA法进行HIT抗体检测,并根据临床4Ts评分法分析其敏感性和特异性。结果：临床诊断HIT患者6例,ELISA法检测HIT抗体对诊断HIT的敏感性为83.3%,特异性为90.0%,阳性预测值为20.8%,阴性预测值为99.4%。结论：4Ts评分系统仍是目前临床诊断HIT的重要依据,HIT抗体的检测对HIT诊断的敏感性及特异性较好、可用于辅助诊断HIT。     

A rare case of arterial thrombosis due to heparin-induced thrombocytopenia

A 78-year-old man presented with an eight-hour history of chest distress. Electrocardiograph and serum cardiac enzymes were suggestive of acute inferior myocardial infarction with right ventricular infarction. The patient, who underwent emergency percutaneous coronary intervention, suffered from thrombocytopenia presenting with cerebral infarction and myocadial reinfarction during haparin exposure. The laboratory test for heparin-induced thrombocytopenia (HIT) specific antibodies (heparin-platelet factor, PF4) was positive. The case was diagnosed as arteries thrombosis due to heparin-induced thrombocytopenia; the patient died after cessation of heparin.

     

Heparin-induced thrombocytopenia associated with pulmonary embolism after total knee arthroplasty： a case report and review of literatures

Type II heparin-induced thrombocytopenia (HIT) is a life-threatening adverse drug reaction initiated by heparin administration. We described a rare case of LMWH-induced HIT complicated with proven pulmonary embolism (PE) in a 75-year-old male patient who hospitalized with diagnose of right knee osteoarthritis and was underwent total knee arthroplasty. The patient was successfully treated with argatroban. Early recognition and timely alternative therapy are of great importance in the treatment of this severe disorder.     

4 例复杂先天性心脏病术后并发肝素诱导的血小板减少症患者的监测

2013年7月至2015年2月中南大学湘雅医院心脏大血管外科收治的复杂先心病接受心脏直视手术的患者中有 4例先后出现肝素诱导的血小板减少症(heparin-induced thrombocytopenia,HIT),通过严密动态监测血小板计数,观察 HIT所致的栓塞性皮肤损伤情况,监测阿加曲班用药效果等综合治疗,3例痊愈,1例死亡。HIT是接受肝素治疗出现 的罕见的严重并发症,栓塞发生率和病死率较高。早期识别、早期诊断高风险人群可以有效改善预后。     

肝素制剂应用患者中血小板减少症的发病率及病因分析

目的：了解住院患者应用肝素制剂后血小板减少症的发病率及原因。方法：选取接受普通肝素（UFH）或低分子量肝素（LMWH）治疗的住院患者共197例,男120例,女77例。对出现血小板减少症的患者进行HIT抗体及凝血功能等检测。结果：应用肝素制剂后出现血小板减少症22例,发病率11.2%。死亡率在血小板减少症组13.6%（3/22）高于非血小板减少症组0.57%（1/175,P〈0.01）。22例血小板减少症患者中肝素诱导的血小板减少症（HIT）6例;非HIT16例,考虑为非免疫性HIT,即I型HIT、血栓性血小板减少性紫癜、弥散性血管内凝血、感染等。结论：应用肝素制剂后血小板减少症的发病率并不低,需结合临床及相关实验室检查加以鉴别,在除外其它原因后应考虑是否存在HIT。     

A randomized controlled clinical trial on piperacillin/tazobactam versus ticarcillin/clavulanic acid for the treatment of bacterial infections

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Successful Treatment of Severe Heparin-induced Thrombocytopenia with Intravenous Immunoglobulin,Platelet Transfusion and Rivaroxaban: A Case Report

Heparin-induced thrombocytopenia (HIT) is a relatively infrequent complication of heparin administration. HIT can cause devastating thrombosis, making it one of the most serious adverse drug reactions encountered in clinical practice. We successfully treated a case of severe HIT presenting with thrombosis and life-threatening bleeding complications with intravenous immunoglobulin (IVIG), platelet transfusion and oral anticoagulant Rivaroxaban. In this case, we considered that IVIG played the most important role by preventing further thrombosis, increasing the platelet count, and ensuring the efficacy of Rivaroxaban. We therefore suggest that IVIG might be the optimal treatment for patients with this urgent condition.     

Heparin induced thrombocytopenia: diagnosis and management update

Heparin-induced thrombocytopenia (HIT) is a potentially devastating immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin. Despite thrombocytopenia, bleeding is rare; rather, HIT is strongly associated with thromboembolic complications involving both the arterial and venous systems. A number of laboratory tests are available to confirm the diagnosis; however, when HIT is clinically suspected, treatment should not be withheld pending the result. Fortunately, therapeutic strategies have been refined, and new and effective therapeutic agents are available. Treatment options are focused on inhibiting thrombin formation or direct thrombin inhibition. Warfarin should not be used until the platelet count has recovered.     

心脏手术患者围术期肝素诱导的血小板减少症

目的：了解心脏手术患者围术期肝素诱导的血小板减少症(heparin-induced thrombocytopenia,HIT)发生率 及其抗体阳性率,探索HIT发病及其抗体产生的影响因素。方法：检测连续的315例心脏手术病例手术前后血小板计 数、HIT抗体、血小板因子4(platelet factor 4,PF4)。按4Ts评分诊断HIT。按性别、年龄、病种等分别统计发生率及其 抗体阳性率并分析影响因素。结果：HIT发生率3.5%(11/315),HIT抗体阳性率36.5%(115/315)。其中冠心病患者HIT 发生率(17.1%)高于心脏瓣膜病患者(1.9%,P<0.05)和先天性心脏病患者(0.8%,P<0.05)。先天性心脏病患者HIT抗体阳 性率(51.7%)高于心脏瓣膜病患者(30.5%,P<0.05),心脏瓣膜病患者HIT抗体阳性率高于冠心病患者(14.6%,P<0.05)。 HIT患者术后严重并发症发生率(36.4%)高于非HIT患者(10.5%,P<0.05)。Logistic回归示HIT发病的影响因素为年龄, HIT抗体产生的影响因素有年龄和体外循环。结论：心脏手术患者围术期HIT发生率较低,但易产生严重并发症,致 残致死率高,应警惕HIT发病的危险因素。     

The impact of the heparin-induced thrombocytopenia (HIT) computerized alert on provider behaviors and patient outcomes

Objective

The aim of this study was to measure the effect of an electronic heparin-induced thrombocytopenia (HIT) alert on provider ordering behaviors and on patient outcomes.

Materials and Methods

A pop-up alert was created for providers when an individual''s platelet values had decreased by 50% or to <100 000/mm³ in the setting of recent heparin exposure. The authors retrospectively compared inpatients admitted between January 24, 2008 and August 24, 2008 to a control group admitted 1 year prior to the HIT alert. The primary outcome was a change in HIT antibody testing. Secondary outcomes included an assessment of incidence of HIT antibody positivity, percentage of patients started on a direct thrombin inhibitor (DTI), length of stay and overall mortality.

Results

There were 1006 and 1081 patients in the control and intervention groups, respectively. There was a 33% relative increase in HIT antibody test orders (p=0.01), and 33% more of these tests were ordered the first day after the criteria were met when a pop-up alert was given (p=0.03). Heparin was discontinued in 25% more patients in the alerted group (p=0.01), and more direct thrombin inhibitors were ordered for them (p=0.03). The number who tested HIT antibody-positive did not differ, however, between the two groups (p=0.99). The length of stay and mortality were similar in both groups.

Conclusions

The HIT alert significantly impacted provider behaviors. However, the alert did not result in more cases of HIT being detected or an improvement in overall mortality. Our findings do not support implementation of a computerized HIT alert.     

肝素诱导的血小板减少症的临床观察

目的 分析静脉血栓栓塞症肝素诱导的血小板减少症及其治疗.方法 对我院2006年5月至2008年5月临床确诊并以肝素抗凝治疗的静脉血栓栓塞症患者202例进行临床分析,定期监测血常规.结果 其中有6例患者发生肝素诱导的血小板减少症,在应用肝素第3～9天出现血小板数目下降,发生率为2.97%,其下降率为60.4%～82.2%.对需要继续抗凝的4例患者停用肝素后改为阿加曲班继续治疗,第3～7天血小板数目回升至入院时水平.结论 在使用肝素进行抗凝治疗期间,应常规监测血小板数目变化,如发现血小板数目进行性下降大于50%,应及时停用肝素,需继续抗凝的患者可改用阿加曲班治疗.     

哌拉西林他唑巴坦在重症患者的肺组织渗透性

目的  研究重症患者哌拉西林和他唑巴坦的肺通透性,并分析影响药物渗透性的相关因素。方法  对重症患者使用标准剂量哌拉西林他唑巴坦后血浆和肺组织内的药代动力学（PK）进行研究。建立群体药动学模型分析血浆和肺内哌拉西林、他唑巴坦的浓度,主要分析哌拉西林达到药效学评估指标的比例,以及肺通透性对哌拉西林和他唑巴坦肺组织渗透性的影响。结果  哌拉西林和他唑巴坦的平均肺组织渗透率分别为49.3%和121.2%。肺内哌拉西林和他唑巴坦的浓度不足,与肺通透性呈负相关。结论  目前哌拉西林他唑巴坦用于治疗敏感菌感染的重症患者时可能疗效不足。

     

哌拉西林/他唑巴坦与亚胺培南/西司他丁随机对照治疗45例细菌性感染的临床疗效观察

目的 评价围产哌拉西林／他唑巴坦安全性和有效性。方法 采用 胺培南／西司他丁作对照药。结果 闰西林／他唑巴坦组与亚胺培南／西司他丁组临床有效率分别为９３．７５％、８７．５０％,细菌清除率分别为８５．７％、７５％。经统计学分析一差异;开放绷带扔拉西林／他唑巴坦治疗１３例细菌感染患者的临床有效率为８４．６２％,总计哌拉西林／他唑巴埋的不良反应发生率为３．４５％,结论哌拉西林／他唑巴坦治疗细菌感染疗效肯     

Trastuzumab-Induced Severe Thrombocytopenia: A Case Report and Literature Review

We present a 29-year-old woman with pT2N0M0 breast cancer, histological diagnosis of invasive ductal carcinoma, ER and PR low positive, and HER-2 (3+). The patient developed trastuzumab-induced thrombocytopenia in 6 hours after an intravenous infusion of trastuzumab at the second cycle of trastuzumab treatment with the symptom of abnormal uterine bleeding. Laboratory exam revealed a sharp drop of platelet count down to 3×10⁹/L. With the treatment of single-donor platelet transfusions, glucocorticoids, oxytocin and thrombopoietic drugs, the platelet count recovered completely in 11 days. This case was confirmed to be severe thrombocytopenia induced by trastuzumab, and retreatment with trastuzumab was not attempted. With increasing clinical utilization of trastuzumab, clinicians are likely to encounter more life-threatening trastuzumab induced severe thrombocytopenia. By this case report and literature review, we hope to increase the awareness, attach the attentions to this condition, and help with the effective treatment.     

Treating heparin-induced thrombocytopenia. The unconventional way!

Heparin-induced thrombocytopenia HIT is a potentially devastating complication of heparin therapy. The severe form of HIT has been associated with both venous and arterial thrombosis manifested by myocardial infarction, cerebrovascular occlusion, skin necrosis or limb ischemia. Several agents are now available as alternatives to heparin in patients with suspected HIT, including the thrombin specific inhibitors lepirudin and argatroban as well as the low molecular weight heparinoid known as danaparoid. When lacking these agents, here we report the use of plasmapheresis to create an artificial state of anticoagulation; exchanging patient's plasma with albumin rather than fresh frozen plasma, to allow the safe introduction of warfarin.     

哌拉西林/他唑巴坦治疗30例自发性腹膜炎的临床观察

目的观察哌拉西林／他唑巴坦（PIP／TAZ）治疗肝硬化合并自发性腹膜炎（SBP）的临床疗效和安全性。方法30侧患者在护肝、利尿、支持、对症治疗的基础上给予哌拉西林／他唑巴坦4．5g，q8h，静脉滴注；主要观察治疗前后患者的临床症状、体征、腹水常规以及药物的不良反应等。结果用哌拉西林／他唑巴坦治疗肝硬化合并自发性腹膜炎的患者．总有效率可达83．33％，不良反应发生率6．67％。结论表明哌拉西林／他唑巴坦可以有效地控制自发性腹膜炎患者的细菌感染，可以作为经验性治疗SBP的首选药物。     

Delayed-onset heparin-induced thrombocytopenia. A potentially malignant syndrome

Delayed-onset thrombocytopenia developed in 12 patients while they were receiving either prophylactic or therapeutic heparin. Five of the patients had thrombocytopenia alone, and seven had thromboembolic complications which contributed to the death of one patient. These complications included deep venous thrombosis (four patients), pulmonary embolism (three patients), myocardial infarction (one patient), sagittal sinus thrombosis (one patient), and femoral artery occlusion (one patient). The diagnosis of heparin-induced thrombocytopenia was delayed for between one and 13 days after the initial complicating event. All patients had heparin-dependent platelet-aggregating factor in their plasma. The characteristics of the heparin-dependent platelet-aggregating reaction were the same in all patients, but the nadir of thrombocytopenia was lower in patients with delayed-onset heparin-induced thrombocytopenia and complicating thromboembolism. These findings highlight the necessity for early recognition of this syndrome and for the prompt withdrawal of heparin to prevent considerable patient morbidity.     

ICU医院获得性肺炎的病原菌分布及耐药性分析

目的 探讨ICU医院获得性肺炎的病原菌分布及其耐药性,指导临床合理用药.方法 对我院2010年1月至2012年12月ICU医院获得性肺炎患者痰培养病原菌及其药敏结果进行回顾性分析.结果 ICU医院获得性肺炎的病原菌以革兰阴性菌为主,占89.06％,而革兰阴性菌中又以非发酵糖菌属及肠杆菌属多见,排在构成比前五位的细菌是肺炎克雷伯菌、铜绿假单胞菌、洋葱伯克霍尔德菌、鲍曼不动杆菌及阴沟肠杆菌,分别占21.09％、17.97％、14.06％、9.38％、9.38％;细菌对抗菌药物有不同程度的耐药率,头孢曲松及头孢噻肟的耐药率高,头孢吡肟次之,而亚胺培南以及哌拉西林/他唑巴坦的敏感性高.哌拉西林/他唑巴坦对肺炎克雷伯菌、铜绿假单胞菌、洋葱伯克霍尔德菌的敏感性优于亚胺培南.结论 ICU医院获得性肺炎的病原菌以非发酵糖菌占优势.哌拉西林/他唑巴坦可能适合于医院获得性肺炎的早期经验性治疗.     

高压氧治疗新型布尼亚病毒感染并发脑炎1例并文献复习

发热伴血小板减少综合征是由一种新布尼亚科病毒引起的疾病,以发热、血小板减少和多脏器功能损害为主要临床表现。该病发病急,病情进展快,病死率约12%~30%,部分患者病情加重会出现神志不清、抽搐、烦躁等神经系统症状。我院近1年来收治了1例新型布尼亚病毒感染引起脑炎患者,采用高压氧配合临床的综合治疗,取得了满意的疗效。现回顾性分析患者的诊治经过并进行文献复习,提高对该疾病合并脑炎的认识及诊治,做到早诊断,早治疗,以降低病死率。