Effect Of Snake Venom Hemagglutinase On Fibrinogen In Patients With Thrombocytopenia And Multivariate Analysis

Objective:To analyze the effect of snake venom hemagglutinase on fibrinogen in patients with thrombocytopenia and multivariate analysis.Methods:Retrospective analysis was performed on 57 cases of snake venom thrombin treated in the Department of Hematology,Nanchang First Hospital from July 2014 to July 2020.They were divided into two groups according to the type of disease :(Aplastic anemia,AA)group and(Immune thrombocytopenic purpura,ITP)group.T-test was used to explore the changes of Fibrinogen(Fib)、Prothrombin time(PT)、Activated partial thromboplastin time(APTT)、Thromboplastin time(TT)、D-Dimer(D-D)、Fibrinogen degradation product(FDP)of snake venom thrombin before and after treatment on thrombocytopenia patients.Patients were divided into two groups according to their post-treatment Fibrinogen levels: low Fibrinogen group(LF group)and normal Fibrinogen group(non-LF group).The indexes of coagulation function,general condition(age,sex,liver and kidney function,basic diseases,basic blood routine level)before and after treatment were compared between the two groups.Univariate analysis was conducted on whether blood transfusion,use of other hemostatic drugs,operation of patients and medication(days of medication,cumulative dosage,source of snake venom)were carried out.The clinical characteristics of patients with hypo Fibrinogenemia were analyzed by binary Logistic regression analysis.Spearman rank correlation analysis was used to analyze the relationship between drug days and cumulative dosage in LF group,and to analyze the correlation between them and post-treatment Fib,? Fib(the difference of Fib value between post-treatment and pre-treatment),post-treatment FDP,? FDP(the difference of FDP value between post-treatment and pre-treatment),and between Fib and ? FDP.Result:1.Among the 57 cases included,there were 23 patients with AA(40.35%)and 34 patients with ITP(59.65%).After the use of snake venom thrombin-like enzyme,the blood coagulation indexes of the two groups showed the same changes,which showed that the level of Fib decreased(t=3.267,5.564,P<0.05)and the level of FDP increased(t=-4.563,-4.014,P<0.01).The changes of other coagulation indexes were not statistically significant(P>0.05).2.Among the 30 patients(52.63%)with hypofibrinogenemia,the average Fib decreased to(0.83±0.268)g/L and the average FDP increased to(11.51±6.360)ug/ml.After stopping the drug(3.78±1.352)days,Fib gradually recovered to(2.06±0.432)g/L,FDP gradually recovered to(3.72±3.575)ug/ml.There were significant differences in sex(P=0.018),age(P=0.005),days of medication(P < 0.001),cumulative dose(P < 0.001)and albumin(P=0.015)between LF group and non-LF group.3.Binary Logistic regression analysis showed that duration of medication(P=0.029,OR=1.326)and cumulative dosage(P=0.005,OR=2.174)are the independent influencing factor of hypofibrinogenemia.4.The duration of medication in LF group had no significant correlation with Fib level and FDP level after medication(r=0.128,0.348,P> 0.05),but had significant correlation with ?Fib level and ?FDP level(r=0.858,P<0.001;r =0.439,P=0.015);Cumulative dosage had no significant correlation with Fib level and FDP level after medication(r=0.131,0.289,P>0.05),but had significant linear correlation with ? Fib level and ? FDP level(r=0.848,P<0.001;r=0.375,P=0.041);There is a significant linear correlation between ? Fib level and ? FDP level in LF group(r=0.441,P=0.015).Conclusion:1.LF may occur in patients with thrombocytopenia after the use of snake venom hemagglutinase,and the corresponding FDP is easy to increase,which may lead to bleeding risk and even DIC.However,there was no significant statistical difference in the changes of PT,APTT,TT and D-dimer before and after drug administration.2.Gender,age,days of medication,cumulative dosage and albumin are all influencing factors for patients prone to hypofibrinogenemia.3.Duration of medication and cumulative dosage are independent influencing factors for LF.4.The days of medication and the cumulative dosage of ?Fib and ?FDP in LF group have significant positive linear correlation respectively,and there is a significant positive linear correlation between the ?Fib level and the ?FDP level in the LF group.