人类白细胞抗原抗体引起输血相关急性肺损伤发病原因分析  

Pathogenetic analysis of transfusion-related acute lung injury caused by human leukocytes antigen antibody against human leukocyte antigen

作　　者：邓晶[1] 徐秀章[1] 叶欣[1] 陈扬凯[1] 丁浩强[1] 刘静[1] 夏文杰[1] 陈大伟[1] 许耀日 Deng Jing;Xu Xiuzhang;Ye Xin;Chen Yangkai;Ding Haoqiang;Liu Jing;Xia Wenjie;Chen Dawei;Xu Yaori(The Key Medical Laboratory of Guangzhou,Guangzhou Blood Center,Guangzhou 510095,China)

机构地区：[1]广州市血液安全重点实验室广州血液中心,广州510095

出　　处：《中华医学杂志》2024年第11期883-887,共5页National Medical Journal of China

基　　金：广州市科技计划(202201011749,2023A03J0549,2023A03J0552,2024A03J0374);广州市医学重点学科(2021-2023);广东省自然科学基金(2022A1515012096);国家自然科学基金(81970169)

摘　　要：2019年9月至2020年10月广州血液中心对临床诊断为人类白细胞抗体引起输血相关急性肺损伤(TRALI)的3例患者进行发病原因分析,包括男2例,女1例,年龄分别为56、50及20岁。通过固相凝集法、抗人球蛋白试验及流式细胞术检测供者体内是否存在针对患者的抗体;采用基于测序的人类白细胞抗原(HLA-SBT)分型技术检测患者的人类白细胞抗原(HLA)基因型;采用Lifecodes HLA-Ⅰ/Ⅱ类单抗原特异性抗体检测试剂(LSA-Ⅰ/Ⅱ),通过Luminex 200液相悬浮芯片系统检测供者血液中的HLA-Ⅰ、Ⅱ类抗体特异性;并分析供者体内针对患者HLA的特异性抗体及相应抗原决定簇。结果显示,供者体内检出针对TRALI患者的HLA-Ⅰ或Ⅱ类特异性抗体,其中患者1接受的供者3血浆中含有针对患者HLA-DRB1^(*)09∶01抗原的抗体,介导供受者抗原抗体反应的抗原决定簇为70R、31I、70QA;供者4血浆中存在针对患者2的HLA-A^(*)11∶02、HLA-A^(*)11∶01、DRB1^(*)12∶02及DRB1^(*)09∶01抗原的抗体,相关抗原决定簇为151AHA、57V和16Y;供者6和供者7血浆中存在针对患者3的HLA-DRB1^(*)14∶04、DRB1^(*)11∶01及DPB1^(*)05∶01抗原的抗体,相关抗原决定簇为96HK、140TV、13SE及111K。通过实验室检测分析明确了3例TRALI病例是由HLA抗体引起的,对临床疑似TRALI病例应重视HLA抗体检测,并给予针对性的诊断及治疗。From September 2019 to October 2020,pathogenetic analysis of three patients clinically diagnosed as transfusion-related acute lung injury(TRALI)caused by human leukocyte antibodies was conducted by Guangzhou Blood Centre,including 2 males and 1 female,aged 56,50 and 20 years old,respectively.Solid phase agglutination,anti-human globulin test and flow cytometry method were used to detect the presence of antibodies against patients.Sequencing-based human leukocyte antigen(HLA-SBT)typing technique was used to detect the human leukocyte antigen(HLA)genotypes of patients.Lifecodes single antigen classⅠ/Ⅱkit(LSA-Ⅰ/Ⅱ)were used to detect the specificity of HLA-classⅠand classⅡantibodies in donor blood by Luminex 200 liquid suspension chip system.The HLA specific antibodies and corresponding epitopes in donors were also analyzed.The results showed that HLA classⅠor classⅡspecific antibodies against TRALI patients were detected in the blood donors.The plasma of donor 3 received by patient 1 contained antibodies against the patient′s HLA-DRB1^(*)09∶01 antigen,and the epitopes mediating the antibody reaction of the donor and recipient were 70R,31I,70QA.There were antibodies against the HLA-A^(*)11∶02,HLA-A^(*)11∶01,DRB1^(*)12∶02,and DRB1^(*)09∶01 antigens of patient 2 in the plasma of donor 4,and the associated antigenic epitopes were 151AHA,57V,and 16Y.Antibodies against the HLA-DRB1^(*)14∶04,DRB1^(*)11∶01,and DPB1^(*)05∶01 antigens of patient 3 were present in the plasma of donor 6 and donor 7,and the associated epitopes were 96HK,140TV,13SE,and 111K.Three cases of TRALI were confirmed to be caused by HLA antibodies through laboratory analysis,and human leukocyte antibody detection should be paid attention in clinically suspected cases of TRALI,and targeted diagnosis and treatment should be given.

关 键 词：人类白细胞抗原 输血相关急性肺损伤 抗体 抗原决定簇 

分 类 号：R457.1[医药卫生—治疗学] R563[医药卫生—临床医学]