COVID-19 患者中抗肝素-PF4(Anti-HPF4)抗体的血清流行率及其与重症监护病房住院和死亡率的相关性

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摘要

摘要 抗肝素-血小板因子 4(抗 HPF4)抗体在肝素诱导的血小板减少症(HIT)中起着关键作用。这些抗体可通过激活血小板参与血栓形成并导致死亡。HIT 是一种危及生命的并发症。最近有报道称,HIT 是 COVID-19 患者血小板减少症恶化的一个风险因素。在本研究中,我们评估了 COVID-19 患者中抗 HPF4 的发生率及其与重症监护室住院和死亡率的关系。这项横断面描述性研究以伊朗西南部亚苏季市的 97 名 COVID-19 患者为对象。入院时和住院期间记录并检查了人口统计学因素、血小板计数、PT、APTT 和 D-二聚体。采用 ELISA 方法对所有符合条件的患者进行了抗 HPF4 抗体检测。统计意义基于双侧设计检验,显著性水平为 0.05。大多数患者(n = 57,58.8%)为男性。患者的平均年龄为(55.46±15.2)岁,平均住院时间为(17.57±7.2)天。平均住院时间为 209.9 ± 79.8 × 103/µL。抗HPF4抗体检测结果显示,9.3%(n = 9)的患者抗HPF4抗体呈阳性。HPF4阳性患者的死亡率较高。虽然这项研究中 HIT 的真实发生率尚不清楚,但可以得出结论,抗 HPF4 抗体参与了 HIT 的病理生理学过程,HIT 是接受肝素治疗的 COVID-19 患者的一种危及生命的并发症,发病率和死亡率都很高。
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The Seroprevalence of Anti-heparin-PF4 (Anti-HPF4) Antibodies Among COVID-19 Patients and Its Relevance to ICU Hospitalization and Mortality

Abstract

Anti-heparin–platelet factor 4 (anti-HPF4) antibodies play a key role in heparin-induced thrombocytopenia (HIT). These antibodies can participate in thrombosis and mortality through platelet activation. HIT is a life-threatening complication. Recently, HIT has been reported as a risk factor of thrombocytopenia exacerbation in COVID-19 patients. In the present study, we assessed the incidence of anti-HPF4 in patients with COVID-19 and the relationship with ICU hospitalization and mortality. This cross-sectional descriptive study was performed on 97 COVID-19 patients in Yasuj City (Southwest zone of Iran). Demographic factors and platelet count, PT, APTT, and D-dimer were recorded and checked at admission and during hospitalization. Anti-HPF4 antibody assay was performed for all eligible patients by ELISA method. Statistical significance was based on two-sided design-based tests evaluated at the 0.05 level of significance. Most of the patients (n = 57, 58.8%) were male. The mean age of the patients was 55.46 ± 15.2 years, and the mean hospitalization was 17.57 ± 7.2 days. The mean length of stay was 209.9 ± 79.8 × 103/µL. The results of the anti-HPF4 antibody assay showed that 9.3% (n = 9) of the patients were positive for anti-HPF4 antibody. The mortality rate was higher in the HPF4-positive patients. Although the true frequency of HIT in this study was unclear, it can be concluded that anti-HPF4 antibodies are involved in the pathophysiology of HIT which is a life-threatening complication in COVID-19 patients receiving heparin treatment, with a high rate of morbidity and mortality.

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