Patent Application
20230213497
The present invention relates to a method for measuring blood coagulation time.
A blood coagulation test is a test for diagnosing blood coagulability of a patient by adding a prescribed reagent to a blood specimen of the patient and measuring, for example, the blood coagulation time. Typical examples of the blood coagulation time include prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time. The blood coagulation test can examine the hemostatic ability and fibrinolytic capacity of a patient. An abnormality in the blood coagulation ability mainly causes elongation of the coagulation time. For example, elongation of coagulation time is caused by, for example, effect of an anticoagulant, reduction of a coagulation-participating component, congenital deficiency of a blood coagulation factor, and an acquired autoantibody that inhibits coagulation reaction.
In recent years, automated analyzers that perform automatic measurement for blood coagulation tests are being widely used, and blood coagulation tests can be easily carried out. For example, in some kind of automated analyzer, a mixed solution obtained by adding a reagent to a blood specimen is illuminated with light, and the coagulation reaction of the blood specimen is measured based on the resulting change in the amount of light. For example, when the amount of scattered light is measured, the scattered light intensity is sharply increased, by progression of coagulation, at a point of time after a certain amount of time has passed since the addition of the reagent to a blood specimen, then saturates as the coagulation reaction approaches the end, and reaches the plateau. The blood coagulation time can be measured based on such a temporal change in scattered light intensity.
As the method for calculating coagulation time by an automated analyzer, several procedures, such as a percentage method and a differentiation method, are used (see Patent Literature 1). When the coagulation time is calculated based on the amount of scattered light, in a percentage method, typically, the time until the measured scattered light intensity reaches a certain percentage of the maximum value thereof is calculated as the coagulation time. The percentage method can quite accurately calculate the coagulation time not only of a normal sample but also of an abnormal sample, such as a low-fibrinogen sample, a chyle sample, and a hemolyzed blood sample. However, the automatic analysis based on the percentage method needs to set the sample measurement time long such that the maximum amount of scattered light can be detected even in an abnormal sample with low coagulability, such as a low-fibrinogen sample. Therefore, the analysis takes time.
In a differentiation method, typically, the time until the differential value of the amount of scattered light reaches the peak or a certain percentage thereof is calculated as the coagulation time. However, in the abnormal sample with low coagulability, such as a low-fibrinogen sample, no clear peak of the differential value of the amount of scattered light is observed in some cases. In addition, in the abnormal sample, two or more peaks of the differential value are observed in some cases. A procedure of calculating the coagulation time based on a single-peak curve formed by fitting of a differential value curve may be used, the fitting impairs the accurate information relating to the coagulability of a sample in some cases.
Furthermore, photometric data from an analyzer include various noises caused by the apparatus, the reagent, and the condition of the sample, and the noises may produce false detection of the coagulation time. The automatic analysis of a blood specimen is required to calculate reliable coagulation time by removing the bad influence of noises.
The present invention relates to a method for measuring blood coagulation time that can accurately measure coagulation time of blood specimens showing various blood coagulation reaction curves.
That is, the present invention provides the followings:
[1] A method for measuring blood coagulation time, comprising:
acquiring coagulation reaction P(i) of a subject specimen and reaction velocity V(i) as a differential value of the reaction P(i), where i represents a measuring point;
calculating a calculation start point Te by using a ratio of V(i) to maximum reaction velocity as an index; and
calculating time Tc giving P(Tc)=P(Te)×N % (0<N<100) and determining the Tc as blood coagulation time;
[2] The method according to [1], wherein the maximum reaction velocity is a maximum value of V(i) acquired so far;
[3] The method according to [1] or [2], wherein the maximum reaction velocity is a maximum value of V(i) acquired after V(i) exceeds a threshold Vs until a latest measuring point;
[4] The method according to any one of [1] to [3], wherein time at which V(i) reaches S % (S is a prescribed value within a range of from 5 to 95) of a maximum reaction velocity after V(i) arrives at the maximum reaction velocity is calculated as the calculation start point Te;
[5] The method according to [4], wherein
time at which V(i) reaches S % (S is a prescribed value within a range of from 5 to 95) of a maximum reaction velocity in a case where a maximum value continuation width K(i) exceeds a threshold Ks after V(i) arrived at the maximum reaction velocity is calculated as the calculation start point Te, where
the maximum value continuation width K(i) is the time or the number of measuring points at which V(i) at i continues to be a certain value after arriving at the maximum reaction velocity;
[6] The method according to [4] or [5], wherein
time at which V(i) is S % (S is a prescribed value within a range of from 5 to 95) of the maximum reaction velocity in a case where a peak width W(i) exceeds a threshold Ws is calculated as the calculation start point Te, where
the peak width W(i) is a time width or number of measuring points between a latest i and a point at which V(i) is X % of the maximum reaction velocity before arriving at the maximum reaction velocity, where
X is 1 or more and less than 100;
[7] A method for measuring coagulation factor concentration, comprising measuring coagulation factor concentration of a subject specimen based on blood coagulation time of the subject specimen measured by the method according to any one of the [1] to [6]; and
[8] The method according to [7], wherein the coagulation factor is fibrinogen.
According to the method of the present invention, coagulation times of blood specimens showing various blood coagulation reaction curves including a normal sample and an abnormal sample can be accurately measured. In addition, when a large number of samples are analyzed at real time with an automated analyzer, the method of the present invention can shorten the analysis time for one sample and can improve the analysis efficiency, compared to a conventional percentage method.
In a blood coagulation test, a prescribed reagent is added to a blood specimen, a subsequent blood coagulation reaction is measured, and blood coagulation time is measured from the coagulation reaction. In the present specification below, a blood specimen may be referred to as a sample. As the measurement of a blood coagulation reaction, a general method, for example, an optical method that measures the scattered light intensity, transmittance, absorbance, or the like, or a mechanical method that measures the viscosity of plasma is used. The coagulation reaction curve of a normal sample depends on the measurement method, but basically shows a sigmoid shape. For example, a coagulation reaction curve based on the scattered light intensity of a normal sample is usually sharply increased by progression of coagulation at a point of time when a certain amount of time has passed since the addition of the reagent, and then reaches the plateau as the coagulation reaction approaches the end. In contrast, the coagulation reaction curves of abnormal samples with coagulation disorder show various shapes depending on the cause of the abnormality, such as delay of the curve rise time and a gradual increase. The variety in the coagulation reaction curve of an abnormal sample makes accurate measurement of coagulation time in an automated analyzer difficult.
In conventional general measurement of blood coagulation time, data at least until the end of coagulation reaction are acquired, and the coagulation time is calculated based on the acquired data. For example, in the case of calculating coagulation time based on the amount of scattered light, there are, for example, a procedure of judging a point of time at which the scattered light intensity is saturated as the end of coagulation reaction, and then determining a point of time at which the coagulation reaction curve reaches the maximum velocity or 1/N thereof during from the time of addition of the reagent until the time of the end of coagulation reaction as the coagulation time (a differentiation method), and a procedure of determining a point of time at which the scattered light intensity reaches 1/N of the amount of scattered light at the end of coagulation reaction as the coagulation time (a percentage method, see Patent Literature 1). However, false detection of the peak of a coagulation reaction velocity or the end of coagulation reaction is caused by abnormal shapes and noises of coagulation reaction curves of abnormal samples as described above, and, for example, the peak of a reaction velocity and the reaction end are detected at a too early point of time in some cases. Such false detection leads to calculation of inaccurate coagulation time.
Since an automated analyzer efficiently analyzes a large number of samples, it is desirable to promptly end the measurement after acquisition of necessary data of one sample and to start measurement of a next sample. However, such a procedure has a risk of inviting the end of measurement too early due to the above-described false detection of the end of coagulation reaction at a too early point of time and causing missing of necessary data. On the other hand, if the coagulation reaction measurement time for one sample is fixed as a sufficiently long time, it is possible to prevent data missing due to false detection of the end of coagulation reaction. However, such a procedure makes the measurement time of a large number of samples unnecessarily long and thereby reduces the total analysis efficiency.
The present invention can prevent false detection of the coagulation time resulting from the abnormal shape of a coagulation reaction curve as described above to allow accurate coagulation time measurement. In addition, according to the present invention, since minimum necessary coagulation reaction measurement time can be applied to individual coagulation time measurements of various blood specimens including a normal sample and an abnormal sample, the analysis time for one sample can be shortened.
The present invention relates to a method for measuring the blood coagulation time of a blood specimen. The method for measuring blood coagulation time of the present invention (hereinafter, also referred to as the method of the present invention) measures the coagulation reaction of a subject blood specimen mixed with a reagent. The blood coagulation time is measured based on the data in the time series of the coagulation reaction obtained by this measurement. Examples of the blood coagulation time to be measured by the method of the present invention include prothrombin time (PT), activated partial thromboplastin time (APTT), and coagulation time in fibrinogen (Fbg) concentration measurement. In the present specification below, the method of the present invention will be mainly described using activated partial thromboplastin time (APTT) as an example of the coagulation time. The method of the present invention can be changed to another coagulation time (for example, prothrombin time (PT)) by those skilled in the art.
In the method of the present invention, as the subject blood specimen, plasma of a subject is preferably used. An anticoagulant that is usually used in a coagulation test may be added to the sample. For example, plasma is obtained by sampling blood with a blood collection tube containing sodium citrate and then performing centrifugation.
A coagulation time measurement reagent is added to the subject specimen to start blood coagulation reaction. The coagulation reaction of the mixed solution prepared by addition of the reagent can be measured. The coagulation time measurement reagent to be used can be arbitrarily selected depending on the measurement purpose. The reagents for measuring various types of coagulation time are commercially available (for example, APTT reagent Coagpia APTT-N, manufactured by Sekisui Medical Co., Ltd.). As the measurement of coagulation reaction, a general method, for example, an optical method that measures the amount of scattered light, transmittance, absorbance, or the like, or a mechanical method that measures the viscosity of plasma may be used. The point of time of starting coagulation reaction can be typically defined as the point of time at which the coagulation reaction is started by adding a reagent to a sample, but another timing may be defined as the point of time of starting the reaction. The time for continuing the measurement of coagulation reaction may be, for example, from several tens of seconds to about 7 minutes since the point of time of mixing a sample and a reagent. This measurement time may be an arbitrarily determined fixed value or may be until the point of time at which the end of coagulation reaction of each sample is detected. Furthermore, in the method of the present invention, measurement of a sample may be ended at a point of time at which the coagulation time of the sample is determined before the completion of coagulation reaction, and measurement of a next sample may be started. During the measurement time, measurement of the state of progress of the coagulation reaction (in the case of optical detection, photometry) is repeated at predetermined intervals. For example, measurement may be performed at 0.1 second intervals. The temperature of the mixed solution during the measurement is, for example, 30° C. or more and 40° C. or less under normal conditions, preferably 35° C. or more and 39° C. or less. Various conditions of measurement can be appropriately set depending on the subject specimen, reagent, measurement methods, and so on.
A series of procedure in the above-described measurement of coagulation reaction can be performed using an automated analyzer. An example of the automated analyzer is automated blood coagulation analyzer CP3000 (manufactured by Sekisui Medical Co., Ltd.). Alternatively, the procedure may be partially manually performed. For example, preparation of subject specimens is performed by a human, and the subsequent procedure can be performed with an automated analyzer.
A coagulation reaction curve based on the amount of scattered light as shown in
The present invention will now be described with reference to the basic flow of an embodiment of the method for measuring blood coagulation time according to the present invention shown in
In the method of the present invention, the measurement data R(i) (measured values of the amount of scattered light) about coagulation reaction measured from the point of time of starting reaction is successively acquired by an analyzer. Here, “i” represents the measuring point number. For example, when the measuring (photometric) interval is 0.1 seconds, the R(i) represents the measured value after 0.1×i seconds since the start of measurement.
Since the measurement data R(i) includes noises at the time of measurement and a fluctuation unrelated to the reaction appearing immediately after the start of light measurement, the measured values are subjected to smoothing processing by a known method. When photometry of a coagulation reaction is performed using the amount of scattered light, zero point adjustment treatment, which is subtraction of the amount of scattered light derived from the reaction solution before the reaction, is performed. Accordingly, the acquired measurement data R(i) are successively subjected to smoothing processing and zero point adjustment to acquire reaction P(i) (step 1). The smoothing processing of measurement data can use any of various known methods relating to noise removal. Examples of the smoothing processing include filtering processing and processing by determining the difference value or the differential value by calculation of an average slope within the intervals described later and then integrating the values. In the zero point adjustment, for example, the smoothed measured value may be adjusted such that the value at the point of time of starting measurement is 0. Furthermore, the measurement data R(i) may be subjected to initial fluctuation removing treatment. The initial fluctuation removing treatment may be performed such that all values during from the time of starting photometry until previously determined time of removing initial fluctuation are 0. Basically, as shown in
Reaction velocity V(i) is acquired from the determined reaction P(i) (step 2). V(i) is obtained by primary differentiation of P(i). The differentiation treatment can be performed by an arbitrary procedure, for example, by calculation of the average slope value within the intervals. In the calculation of the average slope value within the intervals, a certain number of measuring points before and after each measuring point i, for example, (2K+1) measuring points from i−K to i+K can be used. For example, 5 measuring points: the points of i−2, i−1, i, i+1, and i+2, can be used. The average slope value means the slope value obtained by linear approximation of these plurality of measuring points. As the calculation method of the linear approximation, a usual method, such as a least-squares method, can be used. The average slope value of these measuring points can be recognized as the primary differential value at the measuring point i. In the present specification below, P(i) and V(i) may be simply abbreviated to P and V, respectively.
The relative differences between the shapes of reaction P and shapes of reaction velocity V of a normal sample having normal APTT and a factor VIII (FVIII) deficiency sample as an example having elongated APTT (hereinafter, elongation sample) will be described with reference to
The method of the present invention calculates coagulation time Tc using the values of the above-described reaction P(i) and reaction velocity V(i). The method of the present invention can acquire P(i) and V(i) in parallel to the coagulation reaction measurement process.
First, the maximum reaction velocity Vmax is determined based on V(i) acquired so far (step 3). The Vmax most simply represents the maximum value of V(i) acquired so far. On the other hand, on the occasion of determining the Vmax, it is necessary to remove noises from the measuring instrument, which are observed in the coagulation reaction initial stage, and the influence by initial abnormal reaction (so-called early reaction). Accordingly, the Vmax is preferably the value of the peak top of the maximum peak after V(i) exceeded a prescribed threshold for removing noises.
Preferably, in the method of the present invention, when a peak of successively obtained V(i) has a prescribed width, the value of the peak top of the peak is determined as Vmax.
S1 shows V(i) until a point of time T1 immediately after the rising of coagulation reaction. The V(i) (=V(T1)) at T1 is not higher than the velocity threshold Vs. Vs is the velocity threshold for excluding initial noises. When V(i) exceeded Vs, research of Vmax is started.
S2 shows V(i) until a point of time T2 during increasing of the coagulation velocity. Vp is a tentative peak and represents the maximum value of V(i) acquired after V(i) exceeds the Vs until the latest measuring point. Vp is represented by the function Vp(t) at time t or the function Vp(i) of a measuring point. The V(i) (=V(T2)) at T2 exceeds the Vs and is the maximum value of V(i) at the point of time T2 (that is, Vp(T2)=V(T2)), but does not arrive at the peak top yet.
S3 shows V(i) until the point of time T3 at which V(i) arrived at the peak top, where Vp(T3)=V(T3).
S4 shows V(i) until the point of time T4 after V(i) passes through the peak top and starts to decrease. The maximum value Vp(T4) of V(i) at T4 remains in the peak top (=V(T3)). K is the maximum value continuation width and represents the width (or number of measuring points) of the time during which Vp continues to be a constant value, i.e., to be the peak top (=V(T3)). K is represented by the function K(t) at time t or the function K(i) of a measuring point. For example, K(T4) in the figure represents K at the point of time T4 and corresponds to the time width from the point of time T3 of the peak top until time T4. K(i) at the point of time T4 is the value obtained by multiplying the K(T4) by the measurement frequency (number of measuring points/sec) of coagulation reaction measurement.
S5 shows V(i) further decreased until the point of time T5. Vp continues to be the peak top V(T3) until the point of time T5, and K(T5) exceeds the maximum value continuation width threshold Ks (that is, K(T5)>Ks). On this occasion, Vp(T5) (=V(T3)) is determined as tentative maximum value Vmax0.
S6 shows V(i) at the detection end point Tt of Vmax. Tt is the point (the point of time or measuring point) at which V(i) decreased until a prescribed value, after the Vmax0 detection, while K(i)>Ks is maintained. Tt in S6 is defined as a point of time at which V(i) is decreased to 50% of Vmax0, but can be arbitrarily set. Preferably, Tt is a point at which V(i) is 40% to 95% of Vmax0. Vmax0 is determined as true maximum value Vmax at the point of time Tt, and the time satisfying V(i)=Vmax is determined as maximum value time VmaxT. On the other hand, after the Vmax0 detection, if V(i) increases again without decreasing to the prescribed value and exceeds the Vmax0, K(i) is reset to 0, and S2 to S5 are carried out again to detect new Vmax0.
Table 1 shows the states of V(i) in S1 to S5.
When V(i) does not exceed the velocity threshold Vs within the measurement time, it is judged that there is no coagulation reaction. When V(i) exceeds the Vs within the measurement time but the maximum value continuation width K does not exceed the threshold Ks, it is judged that the coagulation reaction is not ended yet. Even if the detection end point Tt cannot be detected after detection of Vmax0 and Vmax is not determined, it is judged that the coagulation reaction is not ended yet.
In another embodiment, Vmax can be determined based on the peak width W of V(i). The peak width W is the width (time or number of measuring points) between the latest point and the point at which the height of V(i) is X % of a tentative peak Vp before the latest point and before Vp. X is 1 or more and less than 100 and is preferably 40 to 95. X is preferably larger than parameter S that is used for calculating a calculation start point Te described later, but may be equal to or smaller than the S. In more detail, when the coagulation time to be measured is APTT, X is preferably 41 to 80, and when the coagulation time is PT, X is preferably 40 to 95. In the present specification, the peak width W may be called as “X % peak width” according to X as the reference. In this procedure, as in the above-described process, after V(i) exceeded Vs, Vp is successively detected, and the peak width W(t) at time t or the peak width W(i) at a measuring point i are determined. When the peak width W exceeds a peak width threshold Ws, Vp is determined as tentative maximum value Vmax0, and then at the point of time Tt (the definition is the same as above), the Vmax0 is determined as true maximum value Vmax, and the time satisfying V(i)=Vp is determined as maximum value time VmaxT. Alternatively, more simply, Vp at Tt may be defined as true maximum value Vmax. However, when the peak width W does not exceed a threshold Ws within the measurement time, it is judged that the coagulation reaction is not ended yet.
As the velocity threshold Vs, the maximum value continuation width threshold Ks, and the peak width threshold Ws, fixed values previously determined can be respectively used. For example, appropriate Vs, Ks, and Ws can be set by measuring coagulation time for a reference sample pack including a normal sample and various types of abnormal samples and using the resulting data of V(i) for the pack. For example, Vs is set to a value smaller than the smallest Vmax in those of each sample determined from the measurement data of the reference sample pack. Regarding Ks and Ws, the maximum value continuation width K and peak width W of each sample of the reference sample pack were determined by the above process, and appropriate values may be set as Ks and Ws based on the determined K and W, respectively. Preferably, Ks is set to a value smaller than the smallest value of the maximum values of K(i) (hereinafter, referred to as Kmax) determined for each sample, and Ws is set to a value smaller than the smallest value of the maximum values of W(i) (hereinafter, referred to as Wmax) determined for each sample.
Alternatively, the velocity threshold Vs, the maximum value continuation width threshold Ks, and the peak width threshold Ws may be functions of time t or measuring point i. Even when Vs, Ks, and Ws are functions of t or i, the functions may be set based on the values of Vmax, Ks, and Ws determined from each sample of the reference sample pack, as in the above. For example, Vs can be set as a function represented by a curve showing a value always smaller than Vmax on a graph plotting the Vmax determined from each sample against VmaxT. Similarly, Ks and Ws can be set as functions represented as curves showing values always smaller than Kmax and Wmax, respectively, on a graph plotting the Kmax and Wmax determined from each sample against VmaxT. In a preferable embodiment, functions Vs, Ks, and Ws are, for example, calculated by the process described in Reference Example 1 described later and can be determined by the following equations:
Vs=b+(a/t2)
Ks=b′+(a′×t2)
Ws=b″+(a″×t2)
[a, a′, a″, b, b′, and b″ are coefficients, and t is time (sec)]
Alternatively, Vs, Ks, and Ws can be determined as functions of measuring point i by converting t in the above equations into i. Even when the reaction velocity V(i) is small or bimodal as often observed in abnormal samples, Vmax can be appropriately detected by using variable values as Vs, Ks, and Ws.
After the determination of Vmax, a point Te at which V(i) is S % of Vmax (100%) after the time of VmaxT is determined (step 4). Te is a point of time (or measuring point) that is recognized such that the coagulation reaction proceeded to a considerable extent and is calculated based on a ratio of V(i) to maximum reaction velocity Vmax (hereinafter also referred to as “maximum velocity ratio”). Here, S° corresponds to a maximum velocity ratio, and VmaxT<Te. S can be determined within a range of larger than 0 and smaller than 100 and is preferably 1 to 95 and more preferably 5 to 95. The smaller S is, the better the measurement precision of the coagulation time tends to be, but the longer the required measurement time is. When the coagulation time to be measured is APTT, S is further preferably 5 to 40 and further preferably 5 to 20. When the coagulation time is PT, S is further preferably 5 to 40 and further preferably 5 to 15. In the method of the present invention, Te is used as the calculation start point of coagulation time.
Subsequently, a point of time Tc at which P(i) is N % of P(Te) (P(Tc)=P(Te)×N %) is determined using P(i) acquired until Te (step 5). The resulting Tc is determined as the coagulation time. N may be 0<N<100 and is preferably 10 to 70 and more preferably 20 to 60.
As shown in Examples below, the coagulation time Tc based on the maximum velocity ratio calculated by the method of the present invention has a high correlation with the coagulation time by a percentage method, which is a conventional common method (for example, a method for calculating the time for P(i) to reach a certain percentage of its maximum value Pmax as the coagulation time). Accordingly, the coagulation time of a subject specimen can be precisely determined by the method of the present invention. Furthermore, in the method of the present invention, coagulation time measurement that is unlikely to receive influences, such as measurement noise and early reaction, and has higher reliability is possible by the step of detecting a true peak of reaction velocity V(i) (step 3 described above).
Furthermore, in the method of the present invention, it becomes possible to determine the coagulation time when reaction velocity V(i) arrived at a prescribed threshold (Vmax×S %) after reaching maximum reaction velocity Vmax. Accordingly, in the method of the present invention, it is not necessary to continue the measurement until the coagulation reaction reaches the plateau, unlike the conventional percentage method. Furthermore, also when a large number of samples are analyzed by an automated analyzer, according to the method of the present invention, it is not necessary to set a long measurement time for an abnormal sample with low coagulability, unlike the conventional percentage method. Accordingly, according to the present invention, it is possible to reduce or optimize the analysis time of samples and thereby improve the analysis efficiency.
A normal blood includes coagulation factors, such as coagulation factors I to XIII, and abnormality and deficiency of these coagulation factors lead to abnormality of coagulability. Generally, the coagulation factor concentration of a subject specimen can be measured using a dedicated reagent for each coagulation factor based on the coagulation time of a measurement sample prepared from the subject specimen. Accordingly, the coagulation factor concentration of the subject specimen can be measured using the coagulation time of the measurement sample measured by the method of the present invention. Generally, the coagulation factor concentration is measured based on a standard curve showing a relationship between coagulation time and coagulation factor concentration. Accordingly, the coagulation factor concentration of the subject specimen can be calculated by applying the coagulation time of the measurement sample measured by the method of the present invention to a standard curve made in advance. Preferable examples of the coagulation factor to be measured by the method of the present invention include factor I (fibrinogen), factor VIII, and factor IX.
In calculation of the coagulation time to be used in measurement of the coagulation factor concentration by the method of the present invention, the threshold (“Vmax×S %”) of V(i) for determining the calculation start point Te based on the maximum velocity ratio is preferably a prescribed value set within a range of 1% to 95% (i.e., S=1 to 95) of Vmax, more preferably 5% to 95% (i.e., S=5 to 95) of Vmax, further preferably 20% to 95% (i.e., S=20 to 95) of Vmax, and further preferably 30% to 75% (i.e., S=30 to 75) of Vmax. In addition, as the X % peak width W for Vmax determination, it is preferable to use a peak width of from 75% to 95%. Here, X is preferably larger than S, but may be equal to or smaller than S.
The method for measuring blood coagulation time of the present invention has been described above by the case of coagulation reaction measurement based on scattered light intensity as an example. However, the method of the present invention can be applied to a method for measuring blood coagulation time using another method for measuring coagulation reaction (for example, a method for measuring blood coagulation reaction based on transmittance, absorbance, viscosity, or the like) by those skilled in the art. For example, the positive and negative of reaction P(i) obtained from an inverse sigmoid-like coagulation reaction curve based on the amount of transmitted light or the like becomes reversed with respect to those based on the amount of scattered light described above. It is obvious to those skilled in the art that in such a case, the signs of P(i) and V(i) in the above-described steps 1 to 4 are reversed, for example, the minimum reaction velocity Vmin is determined instead of the maximum reaction velocity Vmax.
The present invention will now be described in further detail with examples, but is not limited to these examples.
As subject specimens, 9 normal plasma samples and 15 abnormal plasma samples with elongated APTT, 24 samples in total, were used. As the normal plasma, Normal Donor Plasma manufactured by CliniSys Associates, Ltd. was used. In the abnormal plasma, as coagulation factor deficiency plasma (factor deficient plasma), 2 samples each of factor FVIII deficiency plasma, factor FIX deficiency plasma, factor FXI deficiency plasma, and factor FXII deficiency plasma, 2 samples of lupus anticoagulant positive plasma (Lupus Anticoagulant Plasma), and 5 samples of unfractionated heparin-containing plasma (Anticoagulant Plasma) (all of them are manufactured by CliniSys Associates, Ltd.) were used.
As the APTT reagent, Coagpia APTT-N(manufactured by Sekisui Medical Co., Ltd.) was used.
Coagulation reaction measurement was performed using an automated blood coagulation analyzer CP3000 (manufactured by Sekisui Medical Co., Ltd.). Each (50 μL) of the samples was dispensed in a cuvette (reaction container) and was then warmed at 37° C. for 45 seconds, the APTT reagent (50 μL) warmed to about 37° C. was then added to the cuvette, and, after 171 seconds, a calcium chloride solution (50 μL) was further added thereto to start coagulation reaction. The reaction was performed while keeping the temperature about 37° C. The measurement (photometry) of coagulation reaction was performed by irradiating the cuvette with light having a wavelength of 660 nm from an LED light as a light source and measuring the amount of 90-degree side scattered light at 0.1 seconds intervals. The maximum measurement time was 360 seconds (number of data: 3600, 0.1 seconds intervals).
Reaction P(i) was produced by subjecting the photometric data from each sample to smoothing processing including noise removal and then performing zero point adjustment treatment such that the scattered light intensity at the point of time of starting photometry is 0. The primary differential value V(i) was calculated from the P(i).
The APTT of each sample was measured by a percentage method. That is, the point of time at which P(i) arrived at the maximum value Pmax within the measurement time was determined as the coagulation reaction end point, and the point of time at which P(i) reached 50% of the amount of scattered light at the coagulation reaction end point was determined as APTT. Table 2 shows the category and number of subject specimens and the minimum and maximum values of APTT in the samples of each category.
Maximum reaction velocity Vmax was detected from V(i) obtained for each sample. The tentative maximum value Vmax0 when the maximum value continuation width K(i) exceeded the maximum value continuation width threshold Ks and then reached the detection end point Tt (the point of time at which V(i) became 70% of Vmax) was determined as Vmax. The velocity threshold Vs was determined as a function represented by the following equation according to the process of Reference Example 1 described later. Ks was set to 2.2.
Vs(i)=−83+(158214/i2) [i represents a measuring point].
Time Te giving V(i)=Vmax×S % was determined (S=0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, and 95). Time Tc giving P(Tc)=P(Te)×50% was determined as coagulation time. The Te and Tc determined for each S are referred to as Tes and Tcs, respectively, according to the corresponding S. For example, Te and Tc when S is 5 are referred to as Te5 and Tc5, respectively.
The correlation between APTT by a percentage method and APTT(Tc) based on the maximum velocity ratio was evaluated. Each Tc (Tc5 to Tc95) when S was 5 to 95 was subjected to primary regression analysis with APTT by a percentage method, and the slope, intercept, and correlation coefficient of the regression line were determined.
The Tc5 to Tc95 of 24 samples were compared to a control (APTT by a percentage method). Each row of the tables of A and B of
Each of Tc0.5 to Tc5 was subjected to primary regression analysis with APTT by a percentage method by the same process as in 2.1) above, and the slope, intercept, and correlation coefficient of the regression line were determined. The primary regression line of Tc0.5 with respect to APTT by a percentage method for 24 samples is shown in A of
As subject specimens, nine normal plasma samples and 14 abnormal plasma samples with elongated PT, 23 samples in total, were used. As the normal plasma, plasma of normal subjects was used. As the abnormal plasma, plasma of patients administered with warfarin as an anticoagulant and having a PT-INR value, which indicates blood warfarin concentration, of 1 to 2 (five samples), of 2 to 3 (five samples), and of 3 to 4 (four samples) was used.
The coagulation reaction measurement was performed using an automated blood coagulation analyzer CP3000 (manufactured by Sekisui Medical Co., Ltd.). Each (50 μL) of the samples was dispensed in a cuvette (reaction container) and was then warmed at 37° C. for 45 seconds, and a thromboplastin solution (100 μL) warmed to about 37° C. was then added to the cuvette to start coagulation reaction. The reaction was performed while keeping the temperature about 37° C. The measurement (photometry) of coagulation reaction was performed by irradiating the cuvette with light having a wavelength of 660 nm from an LED light as a light source and measuring the amount of 90-degree side scattered light at 0.1 seconds intervals. The maximum measurement time was 300 seconds (number of data: 3000, 0.1 seconds intervals).
Reaction P(i) was produced by subjecting the photometric data from each sample to smoothing processing including noise removal and then performing zero point adjustment treatment such that the scattered light intensity at the point of time of starting photometry is 0. The primary differential value V(i) was calculated from the P(i).
The PT of each sample was measured by a percentage method. The point of time at which P(i) arrived at the maximum value Pmax within the measurement time was determined as the coagulation reaction end point, and the point of time at which P(i) arrived at 45% of the amount of scattered light at the coagulation reaction end point was determined as PT. Table 3 shows the category and number of subject specimens and the minimum and maximum values of PT in the samples of each category.
Maximum reaction velocity Vmax was detected from the V(i) obtained for each sample by the same process as in Example 1. The velocity threshold Vs was determined as a function represented by the following equation according to the process of Reference Example 1 described later. Ks was set to 0.8.
Vs(i)=−148+(51935/i2) [i represents a measuring point].
Time Te giving V(i)=Vmax×S % and time Tc giving P(Tc)=P(Te)×45% were determined (S=5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, and 95), and Tc5 to Tc95 were obtained.
Each of Tc5 to Tc95 was subjected to primary regression analysis with PT measured by a percentage method by the same process as in 2.1) of Example 1, and the slope, intercept, and correlation coefficient of each regression line were determined.
The Tc5 to Tc95 of 23 samples were compared to a control (PT by a percentage method). Each row of the tables of A and B of
Human fibrinogen (Human Fibrinogen manufactured by Enzyme Research Laboratories, Product name: FIB 2) was added to human fibrinogen-removed plasma (Fibrinogen Deficient Human Plasma manufactured by Affinity Biologicals Inc., Product name: Fg Deficient Plasma) to produce a sample (sample 10) with a fibrinogen concentration ([Fbg]) of 980 mg/dL. As standard samples for producing a standard curve, the sample 10 and a physiological saline solution were mixed at volume ratios of 1:9, 7:3, and 10:0 to prepare three samples with fibrinogen concentration ([Fbg]) of 98 mg/dL, 686 mg/dL, and 980 mg/dL, respectively. Separately, the sample 10 and the human fibrinogen-removed plasma were mixed at volume ratios of 1:9 to 10:0 to prepare ten concentration series samples with stepwise different fibrinogen concentrations ([Fbg]) (Table 4).
As the fibrinogen measurement reagents, the thrombin reagent and sample diluent included in Coagpia Fbg (manufactured by Sekisui Medical Co., Ltd.) were used. The coagulation reaction measurement was performed using an automated blood coagulation analyzer CP3000 (manufactured by Sekisui Medical Co., Ltd.). A sample (10 μL) and the sample diluent (90 μL) were dispensed in a cuvette and were warmed at 37° C. for 45 seconds, and a thrombin reagent (50 μL) warmed to about 37° C. was then added to the cuvette to start coagulation reaction. The reaction was performed while keeping the temperature about 37° C. The coagulation reaction measurement was performed by irradiating the cuvette with light having a wavelength of 660 nm from an LED light as a light source and measuring the amount of 90-degree side scattered light at 0.1 seconds intervals. The maximum measurement time was 300 seconds (number of data: 3000, 0.1 seconds intervals). The measurement of coagulation reaction was performed twice for each of three standard samples and ten concentration series samples.
Reaction P(i) was produced by subjecting the photometric data from each sample to smoothing processing including noise removal and then performing zero point adjustment treatment such that the scattered light intensity at the point of time of starting photometry is 0. The primary differential value V(i) was calculated from the P(i).
Since the reaction curve of low-fibrinogen samples continues to rise slowly until the end of measurement in some cases, it is not appropriate to define the maximum value Pmax of a reaction curve as the calculation start point in a percentage method. Accordingly, in the present Example, the calculation start point of a percentage method was determined based on the integrated value ratio Z(i) of reaction P(i) (see Patent Literature 1). The integrated value ratio Z(i) reflects the trend of change in P(i). That is, Z(i) is large in the reaction initial stage in which P(i) increases and then asymptotically approaches 1 as P(i) approaches the plateau. In the present Example, Z(i) was calculated from P(i) by the following equation, and the point at which Z(i) became smaller than a threshold Zs was defined as the calculation start point of a percentage method. Zs was set to 1.05.
Z(i)={P(i+1)+P(i+2)++P(i+m)}/{P(i−m)+P(i−m+1)+ . . . +P(i−1)} (m=20)
Coagulation times of three standard samples and ten concentration series samples were measured by a percentage method. That is, when P(i) at the calculation start point was defined as 100%, the point of time at which P(i) arrived at 63% was determined as the coagulation time. The coagulation time of each sample was measured twice based on the coagulation reaction measurement each performed twice. Regarding the coagulation times measured twice for each of the three standard samples, averages of the duplicate measurements were calculated, and logarithms of the averages were plotted with respect to the logarithms of [Fbg] (mg/dL) of the standard samples to produce a standard curve by a percentage method. According to the produced standard curve, the fibrinogen concentration ([Fbg] arithmetic value by a percentage method, mg/dL) of each of the concentration series samples was calculated.
Maximum reaction velocity Vmax was detected from the V(i) obtained for each sample by the same process as in Example 1. The velocity threshold Vs was determined as a function represented by the following equation according to the process of Reference Example 1 described later. Ks was set to 1.1.
Vs(i)=19+(9357/i2) [i represents a measuring point].
Time Te giving V(i)=Vmax×S % and time Tc giving P(Tc)=P(Te)×63% were determined (S=5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, and 95), and Tc5 to Tc95 were obtained. Tc5 to Tc95 of ten concentration series samples were calculated twice for each to obtain data for 20 samples. In addition, Tc5 to Tc95 of the three standard samples were calculated twice for each, and averages of the duplicate measurements were calculated. Logarithms of the averages were plotted with respect to the logarithms of [Fbg] (mg/dL) of the standard samples to produce a standard curve by Tc. According to the produced standard curve, the fibrinogen concentration ([Fbg] arithmetic value by maximum velocity ratio, mg/dL) of each of the concentration series samples was calculated.
[Fbg] arithmetic values based on Tc5 to Tc95 regarding the data (10 samples×2 of Table 4) of the concentration series samples were compared to expected values (Fbg concentrations of samples shown in Table 4). Each row of the tables of A and B of
The accuracy of a coagulation time measuring method based on the maximum velocity ratio by the present method was compared to the method described in Patent Literature 1 (a coagulation time measuring method using the integrated value ratio Z(i) of reaction P(i)). Z(i) is a ratio of the integrated value of P(i) in a first measurement interval and the integrated value of P(i) in a second measurement interval adjacent to the first interval and reflects the trend of change in P(i). Z(i) is large in the reaction initial stage in which P(i) increases and then asymptotically approaches 1 as P(i) approaches the plateau. In the method described in Patent Literature 1, the time at which Z(i) satisfies a prescribed value after Z(i) became smaller than a threshold Zs is determined as coagulation time. The coagulation time measuring method based on Z(i) is disclosed as a highly reliable coagulation time measuring method that can accurately measure coagulation time of not only a normal sample but also an abnormal sample, such as a low-fibrinogen sample. In the present Example, the accuracy of the coagulation time measuring method according to the present method based on maximum velocity ratio was evaluated by comparison with the coagulation time measuring method using integrated value ratio.
Sample A: a sample prepared by adding unfractionated heparin to a normal plasma such that the unfractionated heparin concentration was 0.9 IU/mL (APTT: 139.0 seconds); and
Sample B: a sample having largest APTT (126.2 seconds) of heparin-containing plasm used in Example 1.
The same as Example 1.
Reaction P(i) was produced by subjecting the photometric data from each sample to smoothing processing including noise removal and then performing zero point adjustment treatment such that the scattered light intensity at the point of time of starting photometry is 0. The primary differential value V(i) was calculated from the P(i). The integrated value ratio Z(i) of the reaction P(i) was calculated by the following equation.
Z(i)={P(i+1)+P(i+2)+ . . . +P(i+m)}/{P(i−m)+P(i−m+1)+ . . . +P(i−1)} (m=20)
Processes for calculating velocity threshold Vs, maximum value continuation width threshold Ks, and peak width threshold Ws based on data of the reference sample pack will be described. As the reference sample packs, 24 samples used in Example 1 (hereinafter, APTT group), 23 samples used in Example 2 (hereinafter, PT group), or the data of 20 samples used in Example 3 (hereinafter, Fbg group) were used. In addition, control P-N for Coagpia (manufactured by Sekisui Medical Co., Ltd.), control P-N I and control P-N II, which are used as precision control samples were also included in the reference sample pack of each group.
Regarding each sample of the reference sample pack, the maximum value Vmax of reaction velocity V(i) during the measurement period was determined. The smallest value of the Vmax obtained from each sample was determined, and 50% of the smallest Vmax was defined as Vs. The determined Vs was 36 in the APTT group, 107 in the PT group, and 17 in the Fbg group.
1) Control P-N I and control P-N II were used as “normal control” and “abnormal control”, respectively. The normal control had the APTT and the Fbg concentration near the center within the reference range. In the abnormal control, the APTT extended over the reference range, and the Fbg concentration was a lower value than the reference range. The reference range is the range of 95% in the center of APTT or Fbg concentration distribution (distribution excluding 2.5% on both sides) of an existing healthy subject pack.
2) The coefficient of a function expression was determined using the measurement data of the normal control and the abnormal control. The maximum velocity time VmaxT of the normal control was defined as X1, and the maximum velocity Vmax was defined as Y1. In the abnormal control, similarly, VmaxT and Vmax were defined as X2 and Y2, respectively.
3) In order to calculate Vs that is smaller than Vmax in the reference sample pack, X1 and X2 were multiplied by a coefficient C (preferably 50%≤C≤90%) to obtain P1 and P2, respectively. In the present Reference Example, C was set to 60%.
4) The function expression was determined as y=b+a/x2, and a and b were determined from simultaneous equations obtained by substituting P1 and Y1 for x and y of the expression and also substituting P2 and Y2 for x and y.
5) Vs was calculated from the determined a and b by an equation Vs=b+a/i2. The calculation equations of Vs determined for the APTT group, PT group, and Fbg group were as follows:
APTT group: Vs(i)=−83+(158214/i2),
PT group: Vs(i)=−148+(51935/i2),
Fbg group: Vs(i)=19+(9357/i2).
However, when the Vs determined by the above equation is less than the fixed value determined in the paragraph 1.1., the fixed value was defined as Vs.
A of
The maximum value (Kmax) of K(i) changes depending on the detection end point Tt, i.e., the value of V(Tt)/Vmax0 ratio. K(i) recedes from VmaxT with an increase in Tt (a decrease in V(Tt)/Vmax0 ratio), and therefore Kmax increases. K(i) approaches VmaxT with a decrease in Tt (an increase in V(Tt)/Vmax0 ratio), and therefore Kmax decreases. The distribution of Kmax was investigated using the measurement data of the reference sample pack and varying the setting of the V(Tt)/Vmax0 ratio (%) from 50% to 90% in 10% increments. As shown in Table 5, it was confirmed that the minimum and maximum values in the distribution of Kmax are affected by the V(Tt)/Vmax0 ratio to show the trend as described above.
B of
The maximum value (Wmax) of W(i) had the same tendency as Kmax, i.e., a tendency of depending on time. As shown in Table 6, the minimum and maximum values in the distribution of Wmax were investigated by varying the set value of V(Tt)/Vmax0 ratio (%) from 50% to 90% in 10% increments.
C of
Vs(t)=−83+158214/t2 [t is time (sec)]
Ks=2.2
Ws=3.4
As shown in
| Number | Date | Country | Kind |
|---|---|---|---|
| 2020-068877 | Apr 2020 | JP | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/JP2021/014697 | 4/7/2021 | WO |
