Application Of Four Coagulation Curve Waveform Analysis Parameters In Coagulation Diseases

With the continuous development of automatic coagulation detection and analysis technology,more and more coagulation parameters emerge at the right moment,which enrich the information of coagulation indicators and contribute to the clinical monitoring of coagulation related diseases.Clot waveform analysis(CWA)is a coagulation curve waveform drawn by a coagulation analyzer that uses the coagulation transmission light principle to detect coagulation indexes such as PT and APTT.A typical APTT solidification curve is the "x" axis represents the time(seconds)and the "y" axis represents the intensity of transmitted light(%).The highest point represents 100%,and the lowest point represents 0%,between 0%and 100%select the preset endpoint(generally set 50%)and determine the coagulation time(CT(s))at this endpoint.The first derivative of the intensity of transmitted light,reflecting the coagulation rate at each time point.|Min1|(dT/dT)is the maximum reaction rate.The second derivative of the transmitted light intensity,reflecting the response acceleration at each specified time point.|Min2|(d2T/dt2)is the maximum coagulation acceleration,and |Max2|(d2T/dt2)is the maximum coagulation deceleration.Objective:To establish the prothrombin time(PT),activated partial clotting enzyme live time(APTT),fibrinogen(Fbg),thrombin time(TT)curve of solidification of waveform analysis(CWA)parameter CT,|Min1| and |Min2|and |Max2| reference interval and the clotting factors,lupus anticoagulant positive patients,patients with reduced genetic differences in the patients with abnormal protein fiber are discussed.Methods:1.125 cases of apparent healthy from August 2019 to January 2020 Peking union medical college hospital physical examination center,the application of CS-5100 automatic blood coagulation analyzer Sysmex detection PT,APTT and Fbg,TT,and record the CWA parameters,respectively set up coagulation four waveform analysis curve of solidification parameters(CWA)CT,|Min1| and |Min2| and |Max2| reference range.2.46 patients with coagulation factor deficiency(factor ?,?),70 patients with positive anticoagulation substance LA were selected to test APTT,and the CWA data of APTT.3.The fibrinogen activity was decreased and the fibrinogen antigen was normal in 4 family members(the proband and her grandfather,father,sister)and her brother fibrinogen activity and the fibrinogen antigen were normal.7 patients with secondary fibrinogen reduction(AL,tumor,Fbg<1.5g/L),all of those patients test Fbg and the CWA data of Fbg.4.SPSS 17.0 and GraphPad Prism 5.0 statistical software was used to conduct statistical analysis of the laboratory examination results of patients.Shapiro-wilk(W-test)was used to verify that if the normal distribution X±2SD represents the reference interval,if the non-normal distribution is P25,P75 represents the reference interval.Comparisons between samples of normal distribution were analyzed by analysis of variance,and comparisons between samples of non-normal distribution were analyzed by the Friedman rank sum test.P<0.05 was considered statistically significant.Result 1.The CWA reference intervals of PT |Min1|(dT/dt),|Min2|(d2T/dt2),|Max2|(d2T/dt2)are3.14±1.22,0.56±0.22 and 0.50±0.18;The CWA reference intervals of APTT |Min1|(dT/dt),|Min2|(d2T/dt2),|Max2|(d2T/dt2)are 4.75± 1.71,0.78±0.29 and 0.65±0.28;The CWA reference intervals of Fbg CT(s),|Min1|(dT/dt),|Max2|(d2T/dt2)are 7.01 ± 1.96,1.22±0.51 and 0.15±0.11;The CWA reference intervals of TT |Min1|(dT/dt),|Min2|(d2T/dt2),|Max2|(d2T/dt2)are 0.95±0.32,0.14±0.05 and 0.07±0.03.2.Hemophilia A,Hemophilia B |Min1|,|Min2|,|Max2| were lower than the normal people.The CWA of deficiency coagulation factor ? patients as factor ? activity reduced significantly reduce.3.The APS patients with lupus anticoagulant 1.2-1.5 of APTT |Min1|(dT/dt),|Min2|(d2T/dt2),|Max2|(d2T/dt2)are 4.89± 1.70,075±0.31,0.61 ±0.30;The APS patients with lupus anticoagulant 1.5-2.0 of APTT |Min1|(dT/dt),|Min2|(d2T/dt2),|Max2|(d2T/dt2)are 4.08± 1.14,0.59±0.20,0.45±0.19;The APS patients with lupus anticoagulant>2.0 of APTT |Min1|(dT/dt),|Min2|(d2T/dt2),|Max2|(d2T/dt2)are 3.69± 1.03,0.47±0.17,0.35±0.14.The parameter of APTT |Min1|(dT/dT),|Min2|(d2T/dt2)and |Max2|(d2T/dt2)showed significantly lower in the patient of APS patients at LA>1.5 than those with LA<1.5,with statistically significant differences(P<0.05).4.The proband and her grandfather,father,sister,fibrinogen activity reduced to some extent,determination of Fbg CWA study parameters computed tomography(CT)in patients with normal and secondary low fibrous protein concentration increased significantly,|Max2| and |Max2|/|Min1|,gene verify the proband and his grandfather,father,sister,all is because of fibrinogen FGG Arg301Cys mutation resulted in the abnormal fibrinogen.Conclusion 1.The detection results of PT,APTT,Fbg and TT CWA parameters can provide the basis for the follow-up studies.2.CWA parameters of APTT decreased in patients with hemophilia,factor? deficiency patients have certain implications.3.Changes in CWA parameters of APTT detection are more sensitive than that of APTT detection time CT as the positive of LA.4.Fbg CWA parameters can distinguish patients with fibrinogen abnormality caused by mutation of FGG-Arg301Cys and acquired fibrinogen deficiency patients.