儿童急性白血病血小板抗体检测及其临床意义  

Platelet antibody and its clinical significance in childhood acute leukemia

作　　者：潘艳莎 贾苍松[1] 周晨燕[1] 顾玲[1] 

机构地区：[1]四川大学华西第二医院儿科,四川成都610041 [2]泸州医学院附属医院儿科,四川泸州646000

出　　处：《中国实用儿科杂志》2013年第12期910-912,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的为了解白血病患儿输注血小板后血小板抗体产生规律及其临床意义,通过检测急性白血病(AL)患儿血小板抗体,探讨血小板抗体产生与血小板输注无效(PTR)的关系。方法收集2010年4月至2011年10月在四川大学华西第二医院儿童血液/肿瘤科住院诊治的急性白血病患儿56例,治疗过程中依据血小板输注次数不同分为3组:患儿在入院后未输注血小板(Ⅰ组)、第2次输注血小板(Ⅱ组)及第5次输注血小板(Ⅲ组)后1 h内采集血液标本。同期收集我院门诊健康正常体检儿童20名作为对照组,均无输血史。先用血小板抗体检测试剂检测所有标本,再将检测阳性标本用PAKPLUS试剂确定HLA-Ⅰ、HPA抗体,并观察抗体阳性患儿血小板输注效果。结果 20名正常对照组检测结果均为阴性。Ⅰ、Ⅱ、Ⅲ组抗体阳性率比较,各组间抗体总体阳性率差异有统计学意义(χ2=8.313,P<0.05)。Ⅱ组抗体阳性率高于Ⅰ组,差异无统计学意义(χ2=3.116,P=0.078)。Ⅲ组抗体阳性率高于Ⅰ组,差异有统计学意义(χ2=13.057,P<0.05)。Ⅲ组抗体阳性率高于Ⅱ组,差异无统计学意义(χ2=1.286,P=0.257)。Ⅱ、Ⅲ组抗体表达阳性组的PTR发生率高于抗体表达阴性组,但差异无统计学意义(χ2=1.163,P>0.05)。Ⅲ组PTR发生率高于Ⅱ组,差异有统计学意义(χ2=10.469,P<0.05)。结论急性白血病患儿血小板抗体阳性率随着血小板输注次数的增多而增加,但血小板抗体阳性患儿不一定发生血小板输注无效。Objective In order to know the rules and the clinical significances of platelet antibody production after platelet transfusion in children with acute leukemia （AL）, we tested the platelet antibody in 56 patients with AL, and discussed the relationship between platelet antibody production and platelet transfusion refractoriness（PTR）.Methods Totally 56 AL children from the Department of Hematology and Oncology of West China Second Hospital of Sichuan Universmy were re- cruitted between April 2010 to October 2011, all of whom were divided into 3 groups according to the different times of platelet transfusion in treatment process ： group I , who didn＇ t receive platelet transfusion group II , who received platelet transfusion for the second time, and group m ,who received platelet transfusions more than 5 times. The blood samples were collected within 1 hour after the platelet transfusion. Ten healthy children from the outpatient department were included as the control group who had no blood transfusion history. We used platelet antibody test agent to test the platelet antibody and the PAKPLUS kit to test the HLA-I and HPA antibodies. In the meantime, we observed the clinical improvements in the children with positive platelet antibodies. Results The incidences of platelet antibody production among the three groups were statistically different（A2 = 8.313, P 〈 0.05）. In group II and III, the platelet antibody positive children had higher rate of invalid transfusion, but the difference was not significant （X2 = 1.163, P 〉 0.05 ）.The rate of invalid transfusion in group III was higher than that in group I1 with statistical differences（A？ = 10.469,P 〈0.05）.Conclusion With frenquency of platelet transfusion increasing, the positive rate of platelet antibody production in AL children is getting higher. But the children with positivity of platelet antibody don＇t necessarily have platelet transfusion refractoriness （PTR）.

关 键 词：急性白血病 血小板抗体 血小板输注 输注无效 

分 类 号：R72[医药卫生—儿科]