108例免疫因素所致血小板输注无效的临床分析  

Clinical Analysis of 108 Cases of Ineffective Platelet Transfusion Caused by Immune Factors

作　　者：孙莉[1] 李明华[1] 叶海辉[2] 

机构地区：[1]襄阳职业技术学院,湖北襄阳441021 [2]襄阳市中心医院检验部,湖北襄阳441000

出　　处：《现代预防医学》2015年第16期3054-3056,共3页Modern Preventive Medicine

基　　金：2013-2014年度湖北省卫生厅采供血管理科研项目:襄阳地区血小板输注无效检测方案的建立及临床应用研究(项目编号:CGX2012-9)

摘　　要：目的探讨免疫因素所致血小板输注无效(PTR)患者的临床分布及血小板抗体类型。方法对108例血小板输注无效且血小板抗体筛查阳性的患者进行血小板特异性抗体的鉴定,分析患者血浆中人类血小板抗原(HPA)和人类白细胞抗原(HLA)抗体的分布,并调查患者临床情况。结果 108名患者以血液系统疾病和肿瘤原发病为主,患者血浆血小板抗体检测结果为,单纯抗-HLA阳性占42.6%,单纯抗-HPA阳性占20.4%,抗-HLA与抗-HPA双阳性占37.0%;患者血小板膜糖蛋白(GP)抗体类型结果为,GPⅡb/Ⅲa达50.0%、GPⅠa/Ⅱa占40.7%,GPⅠb/Ⅸ占16.7%,GPⅣ占27.8%。结论免疫因素引起的PTR患者以HLA抗体为主,HPA抗体类型以GPⅠa/Ⅱa和GPⅡb/Ⅲa为主,对临床反复多次输注血小板患者,进行血小板抗体筛查及鉴定,能有效评价患者输注效果,准确指导临床输血工作。Objective This work aimed to investigate the clinical distribution and platelet antibody types of patients with refractoriness to platelet transfusion（PTR） caused by immune factors. Methods 108 cases of PTR with platelet antibody positive were identified by platelet-specific antibody types. The distribution of plasma HPA and HLA antibodies were analyzed. Meanwhile,the clinical conditions of the patients were also investigated. Results Among the 108 patients, most were diagnosed with blood system diseases and tumors. Plasma platelet antibody test showed that 42.6% of the patients were simple anti-HLA positive, 20.4%were simple anti-HPA positive, and 37.0% were anti-HLA and anti-HPA double positive. The platelet GP antibody typing results showed that the constitute was GP Ⅱb/Ⅲa 50.0%, GPⅠa/Ⅱa 40.7%, GPⅠb/Ⅸ 16.7%, GP Ⅳ 27.8%. GP Ⅰa/Ⅱa and GP Ⅱb/Ⅲa antibodies were expressed the most. Conclusion The major platelet antibody type of patients with PTR caused by immune factors was antibody-HLA. The major types of HPA were GPⅠa/Ⅱa and GP Ⅱb/Ⅲa. For patients repeatly transfused with platelet,screening and identification of antibody type can effectively improve the infusion effect to patients and provide accurate guidance to clinical transfusion.

关 键 词：血小板输注无效 免疫 人类白细胞抗原 人类血小板抗原 

分 类 号：R115[医药卫生—公共卫生与预防医学]