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| 題 名 | 肝素引起血小板低下症及案例報告=Heparin-Induced Thrombocytopenia and a Case Report |
|---|---|
| 作 者 | 邱春吉; 李炳鈺; 江吉文; | 書刊名 | 藥學雜誌 |
| 卷 期 | 27:4=109 2011.12[民100.12] |
| 頁 次 | 頁133-139 |
| 分類號 | 418.2321 |
| 關鍵詞 | 肝素; 血小板低下; 血栓形成; heparin; HIT; Heparin-induced thrombocytopenia; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 肝素引起血小板低下 (heparin-induced thrombocytopenia,HIT) 是一種與使用 heparin 有相關的副作用反應,基本上可分為非免疫型 type I HIT 與免疫型 type II HIT。當肝素引發免疫型反應時,heparin 會與 PF4 結合形成 heparin-PF4 complex,導致抗體產生,抗體隨之與其形成 heparin-PF4 -antibody complex,活化凝血機轉的一連串變化,產生凝血酶和更進一步活化血小板,增加靜脈或動脈血栓形成的危險。然而 HIT 的確定診斷並不容易,仍有許多未明之處,除了血液檢驗值如血小板數與臨床表徵如血栓形成外,亦應配合實驗室檢測如血小板活化試驗 SRA (serotonin release assay) 和抗原試驗 ELISA (enzyme-linked immunosorbent assay) 等項目當診斷的依據。當疑似 HIT 時,應停用 heparin,給予非 heparin 的替代性抗凝劑如直接凝血酶抑制劑和 Xa 因子對抗劑等藥物治療,抑制凝血酶的生成,以減少血栓之形成。本文藉由 HIT 之分類、病理機轉、臨床表現、診斷依據和治療對策之文獻,探討肝素引起血小板低下症及案例報告。 |
| 英文摘要 | Heparin-induced thrombocytopenia (HIT) is a adverse effect associated with heparin use. Essentially, it can be divided into nonimmune type I HIT and immune type II HIT. When heparin induced immune response, it binds to platelet factor 4 (PF4) and the heparin-PF4 complex leading to antibody formation. The heparin-PF4-antibody complex then activates the contact coagulation cascade to produce thrombin and further platelet activation, leading to increase the risk of thrombosis in venous or artery. HIT is often difficult to diagnose, there are still many unknown. In addition to laboratory data (eg, platelet count) and clinical presentation (eg, thrombosis), the serotonin release assay and the enzyme-linked immunosorbent assay are commonly used in the diagnostic testing for HIT. When HIT is suspected, heparin administration should be discontinued, Alternative nonheparin anticoagulant therapy (eg, direct thrombin inhibitor and anti-factor Xa agent) should be initiated promptly for inhibiting thrombin and reducing thrombosis. In this article, we discussed the category, pathogenesis, clinical presentation, diagnosis and management of heparin-induced thrombocytopenia and a case report. |
本系統中英文摘要資訊取自各篇刊載內容。