自免溶贫患者血清学检测结果与贫血程度及输血疗效的回顾性分析  

Retrospective analysis on the relationship between serological test results and anemia/treatment outcomes in AIHA patients

作　　者：张秋会 胡兴斌 安群星 孙文利 张婧 安宁 常艳 严珺 尹文 ZHANG Qiuhui;HU Xingbin;AN QunXing;SUN WenLi;ZHANG Jing;AN Ning;CHANG Yan;YAN Jun;YIN Wen(Department of Blood Transfusion ,Xijing Hospital ,the Fouth Military Medical University ,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院输血科

出　　处：《中国输血杂志》2018年第10期1160-1163,共4页Chinese Journal of Blood Transfusion

摘　　要：目的回顾性总结与分析自身免疫性溶血性贫血(AIHA)患者自身抗体伴直接抗球蛋白试验阳性的凝集强度与贫血程度以及输血治疗的关系,寻求安全有效的输血策略。方法应用试管法、抗球蛋白法与微柱凝胶法,对196例AIHA患者红细胞进行直接抗球蛋白试验(DAT)检测;对血清及红细胞放散液进行间接抗球蛋白试验(IAT)检测,利用谱细胞鉴定患者血清中和致敏在红细胞上的抗体特异性;并分析自身抗体凝集强度和自身红细胞被致敏的强弱与贫血程度以及输血治疗的关系。结果196例AIHA患者中,DAT和IAT均为阳性,且凝集强度为1+—4+不等,共检出自身抗体伴同种抗体86例占43.9﹪(86/196),单独自身抗体65例占33.2%(65/196),类同种特异性自身抗体45例占23.0﹪(45/196)。其中,自身抗体的强度与自身红细胞被致敏的程度呈正相关(P<0.05),而自身抗体和红细胞DAT的凝集强度与贫血呈正相关(P<0.05)与输血疗效呈负相关(P<0.05)。结论AIHA患者自身红细胞被致敏的强弱、贫血的严重程度、输血后的疗效与自身抗体和DAT的凝集强度均有关,其自身抗体凝集强度越强红细胞被致敏的程度越严重。对于此类患者输血前应综合考虑各种因素,根据不同情况采用不同处理方法,指导临床合理安全用血。Objective To retrospectively summarize and analyze the relationship among the agglutination strength of direct and indirect anti Combs tests,the degree of anemia,and the treatment outcomes in AIHA patients,seeking for potential effective blood transfusion strategy. Methods The direct anti Coombs of erythrocytes in 196 patients with AIHA is detected by the test tube method,anti Coombs method and microcolumn gel method. Meanwhile,the serum should be detected by anti Coombs tests. The spectrum result can help to identify the serum and erythrocyte. Antibody were further distinguished by absorption and elution tests. We then analyze the relationship between autoantibodies and autologous red cell agglutination strength,sensitization strength,the degree of anemia and the transfusion outcomes. Results The 196 patients with AIHA were all DAT and IAT-positive. The agglutination intensity fell into the 1+—4+ range. 86 cases were determined to carry autoantibodies with antibodies,accounting for 43. 9%( 86/196). 65 cases were autoantibodies only,accounting for 33. 2%( 65/196) while 45 cases were similar-specific antibodies,accounting for 23( 45/196) %. Among them,positive correlation can be found in the degree of autoantibody intensity and autologous erythrocyte sensitization( P<0. 05),while autoantibodies and agglutination intensity of red blood cell DAT are positively correlated to anemia( P<0. 05) and are negatively correlated to treatment outcomes( P < 0. 05). Conclusion AIHA patients autoerythrocyte sensitization intensity,anemia severity,blood transfusions,curative after blood transfusion are related to autoantibody and DAT agglutination intensity. These patients required careful transfusion planning with numerous factors considered.

关 键 词：自身抗体 直抗阳性 凝集强度 贫血程度 输血治疗 

分 类 号：R556.62[医药卫生—血液循环系统疾病] R457.11[医药卫生—内科学]