act什么监测项目两种ACT检测仪用于住院患者诊断及介入治疗时的检测效能比较

两种ACT检测仪用于住院患者诊断及介入治疗时的检测效能比较

Dalton H, Martin M, Garcia-Filion P, Shavelle D, Huang PH, Clark J, Beinart S, Israel A, Korpi-Steiner N.

Activated clotting time in inpatient diagnostic and interventional settings.

J Thromb Thrombolysis. 2022; 54(4): 660-668.

doi: 10.1007/s11239-022-02672-y.

① 活化/激活凝血时间(Activated clotting time, ACT)是监测普通肝素(Unfractionated heparin, UFH)抗凝效果的重要手段。

② UFH剂量与ACT值之间并非“线性关系”，调整UFH用量有赖于实测ACT值。

③ Signature Elite (SE)-ACT仪已在临床中广泛应用，而GEM H100(GEM)-ACT仪的临床适用性及可重复性尚待评价。

对比评价“GEM-ACT仪vs. SE-ACT仪的检测效果及可重复性”。

①试验设计：多中心、前瞻性研究。

②ACT检测场景：手术室内心脏手术(COVR)、体外生命支持(ELS)、心导管室(CCL)、经皮冠状动脉介入治疗(PCI)、介入放射学(IVR)、心脏电生理检查治疗(EP)。抽取血液样本后，立刻经由SE-ACT仪和GEM-ACT仪行ACT值检测。

③【结局指标】：2种ACT仪检测的可重复性(ACT+＆ACT-LR)、2种ACT仪对同一样本测定值的相关性、检测偏差＆准确性。

①研究队列特征见【Table 1】。检测了1,236对ACT+样本和463对ACT-LR样本(共计1,699份)。

②ACT+测定的“可重复性”：GEM-ACT仪优于SE-ACT仪【Figure 1】。

③ACT-LR测定的“可重复性”：GEM-ACT仪优于SE-ACT仪【Figure 2】。

④当测定值≤250 s时，GEM-ACT仪与SE-ACT仪对同一样本(ACT+/ACT-LR)检测结果的“相关性”最佳【Figure 3】。

⑤检测ACT+样本【Figure 4a】和ACT-LR样本【Figure 4b】时，随着测定数值增大，GEM-ACT仪与SE-ACT仪对同一样本(ACT+/ACT-LR)检测结果的“不一致性”亦增加(尤其当测定值>250 s时)。

⑥pass – bablok回归参数【截距(A)和斜率(B)】分析：与SE-ACT仪相比，在ACT值较大的COVR患者样本，使用GEM-ACT仪检测的ACT+值【Table 2】和ACT-LR值【Table 3】的“检测偏差”最大。在CCL、ECMO、EP和ICU情况下，使用GEM-ACT仪检测的ACT-LR值与SE-ACT仪所测相当【Table 3】

①GEM-ACT仪检测的可重复性高于SE-ACT仪。

②COVR场景(高水平抗凝/高ACT值)，GEM-ACT仪检测ACT+及ACT-LR的检测偏差大于SE-ACT仪。

③CCL、ECMO、EP、ICU场景(低水平抗凝/低ACT值)，GEM-ACT仪与SE-ACT仪检测ACT-LR的准确性相当。

（略）

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