1 秒也不能差！解密凝血酶原時間與INR背後的生命指標

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凝血酶原時間（PT）與國際標準化比率（INR）是監測口服抗凝劑療效的關鍵指標，反映血液凝固能力。透過標準化的試劑與公式計算，讓世界各地的實驗結果更具一致性，確保病人安全。

A brief discussion of prothrombin time

凝血酶原時間的簡要討論

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理解凝血酶原時間和國際標準化比率（INR）
Understanding prothrombin time and INR.

凝血酶原時間（PT）是監測口服抗凝療法的主要方法。PT 的延長取決於三種維生素 K 依賴的凝血因子（II、VII 和 X）的減少。在維生素 K 拮抗劑（VKA）療法的前幾天中觀察到的 PT 變化主要是由於 VII 因子的減少，該因子的半衰期最短為 6 小時。隨後，因子 X 和 II 的減少會進一步導致 PT 的延長。

Prothrombin time (PT) is the primary method used in monitoring oral anticoagulant therapy. The prolongation of PT depends on reductions in three of the vitamin K dependent clotting factors (II, VII and X). Changes in the PT noted in the first few days of vitamin K antagonist (VKA) therapy are primarily due to reductions in factor VII which has the shortest half-life of 6 hours. The reduction of factors X and II subsequently contribute to prolongation of the PT.

可以使用靜脈血或毛細血管血來監測抗凝療法。為了產生結果，將組織因子添加到血液樣本中以激活凝血。這會導致血塊形成。形成這個血塊所需的時間以秒為單位測量，稱為 PT。

Either venous or capillary blood can be used to monitor anticoagulation therapy. To produce a result, thromboplastin is added to the blood sample to activate coagulation. This causes a blood clot to form. The time it takes for this clot to form is measured in seconds and is known as the PT.

凝血酶原酶試劑可以通過多種方法製造，這導致對維生素 K 依賴的凝血因子的減少反應性有所不同。為了使凝血時間儘可能可比，世界衛生組織（WHO）於 1983 年批准了一種標準參考凝血酶原酶。每個凝血酶原酶的製造商必須根據 WHO 國際參考標準（IRP）對其試劑進行校準。所獲得的值稱為國際敏感性指數（ISI）。

Thromboplastin reagent can be produced by a variety of methods, which results in varying responsiveness to a decrease in the vitamin K-dependent coagulation factors. To render coagulation times as comparable as possible, the World Health Organization (WHO) approved a standard reference thromboplastin in 1983. Every manufacturer of thromboplastin must calibrate his reagent against the WHO international reference preparation (IRP). The value obtained is known as the international sensitivity index (ISI).

ISI 用於計算國際標準化比率（INR），這是一種標準化報告方法，旨在使來自世界各地不同實驗室的 INR 具有可比性。 ³

The ISI is used in the calculation of international normalized ratio (INR), which is a standardized reporting method developed to allow for comparability of INRs from different laboratories across the world. ³

INR 方法在糾正使用不同凝血酶原酶的不同實驗室之間的差異方面並不完美，但它確實減少了變異並提供了臨床上有用的結果。為了最小化這種變異，每個監測站應該對每位患者僅使用一種儀器和凝血酶原酶來源的結果。

The INR method is not perfect in correcting for differences between different laboratories utilizing different thromboplastin reagents, but it does reduce the variation and provides clinically useful results. To minimize this variation, each monitoring site should use results from only one type of instrument and thromboplastin reagent origin for each patient.

INR = (患者 PT / 平均正常 PT) ^ISI
INR = (Patient PT / Mean Normal PT) ^ISI

• 平均正常 PT 是約 20 名健康者的幾何平均 PT
  Mean normal PT is the geometric mean PT of about 20 healthy
• 通過血液收集系統獲得的受試者並進行測試
  subjects obtained via the blood-collections system and tested
• 使用與 ISI 相同品牌和批次的凝血酶原時間試劑
  with the same make and lot of thromboplastin as that of the ISI
• 使用中。 ³    in use. ³

例如：一位接受口服抗凝劑的患者的凝血酶原時間為 64 秒（= 18% Quick）。正常血漿的凝血酶原時間為 22 秒（= 100% Quick）。所使用的組織胺的 ISI 為 0.93。將此值代入公式中可得以下 INR：

For example: The PT of a patient receiving oral anticoagulant is 64 seconds (= 18% Quick). The prothrombin time of a normal plasma is 22 seconds (= 100% Quick). The ISI of the thromboplastin used is 0.93. Substituting this value in the formula gives the following INR:

(64) / (22) 0.93 = 2.7 INR

• 這意味著凝血時間比標準長 2.7 倍。
  This signifies a coagulation time that is 2.7 times longer than the standard.
• 患者的凝血時間越長，INR 就越高。The longer the patient’s coagulation time, the higher the INR.

參考文獻 References

1. Hirsh 等人 (2003)。循環 107, 1692–1711
   Hirsh et al. (2003). Circulation 107, 1692–1711
2. Ageno 等人 (2012)。胸部 141 (補充):e44S–e88S
   Ageno et al. (2012). Chest 141 (Suppl):e44S–e88S
3. Boroumand 和 Hamidreza (2010)。德黑蘭大學心臟中心雜誌 2, 57-68
   Boroumand and Hamidreza. (2010). J Teh Univ Heart Ctr 2, 57-68