Eplets配型方法在HLA-Ⅰ类抗体所致血小板输注无效患者中的应用评价  

The Application of Eplets matching in patients with platelet transfusion refractoriness caused by HLA class Ⅰ antibody

作　　者：邓晶[1] 叶欣[1] 徐秀章[1] 丁浩强[1] 陈扬凯[1] 邵媛[1] 夏文杰[1] 王嘉励[1] 刘静[1] 陈大伟[1] Jing;YE Xin;XU Xiuzhang;DING Haoqiang;CHEN Yang kai;SHAO Yuan;Xia Wen Jie;WANG Jia Li;LIU Jing;CHEN Da Wei.(Institute of Blood Transfusion, Guangzhou Blood Center, The KeyMedical Laboratory of Guangzhou, Guangzhou 510095, China)

机构地区：[1]广州血液中心广州市医学(血液安全)重点实验室

出　　处：《中国输血杂志》2018年第4期384-387,共4页Chinese Journal of Blood Transfusion

基　　金：广东省医学科研基金(A2016616);广州市科技计划项目(201707010021/201707010442/201607010007);国家自然科学基金青年项目(81601451);广东省自然科学基金(2016A030313124/2016A030313123)

摘　　要：目的了解Eplets配型方法在HLA-Ⅰ类抗体所致血小板输注无效（PTR）患者中的适用性。方法以PCR-SBT方法检测24名PTR患者及血小板供者的HLA基因型;利用Luminex技术平台、采用抗-HLA检测试剂（LSA）检测患者的HLA特异性抗体（DSA）;再借助HLA Matchmaker软件获得患者的预存HLA-Ⅰ类抗体对应的表位（Eplets）及DSA荧光指数中值（MFⅠ）;最后统计分析Eplets错配数对PTR的影响。结果对DSA不同MFⅠ阈值（1 000—3 000）的统计分析：DSA MFⅠ〈1 000时的血小板输注效果最佳,且随着DSA MFⅠ的增加,血小板输注效果均出现不同程度的下降。本组32次输注有效与PTR患者的DSA MFⅠ平均值分别为1 289.67±1 121.83 vs 4 078.60±2 578.57（P〈0.01）,Eplets错配数0—5的患者与错配数〉5的患者输注效果分别为29.38±22.47 vs 18.47±15.38（P〉0.05）。结论 Eplets配型方法结合DSAMFⅠ水平可筛选到适合的血小板供者,从而避免对于HLA-Ⅰ类抗体所致的PTR,保证输注效果。Objective To investigate the potential of Eplets matching in patients with platelet transfusion refractoriness caused by HLA-Ⅰ antibody through the analysis of the effect of donor-specific antibody（DSA） level and donor-specific antibody mismatch on the efficacy of platelet transfusion. Methods The HLA genotypes of 24 PTR patients and other platelet donors were detected by PCR-SBT. HLA-specific antibodies were detected by Luminex technology platform using LSA reagent. Then donor-specific HLA-class Ⅰ antibodies were obtained by HLA Matchmaker software. The effect of DSA MFI and the donor-specific antibody mismatch number on the efficacy of platelet transfusion was analyzed. Results Pre-deposited donorspecific HLA-class Ⅰ were obtained by HLA Matchmaker software. And through the statistical analysis of different MFI thresholds（1000-3000） of DSA,wefound that a MFI value of DSA lower than 1000 yielded a platelet transfusion efficiency of28. 90,and offered optimizedtransfusion effect. Interestingly,with the increased DSA MFI,the effect and transfusion efficiency declined. Furthermore,mean DSA MFIs were significantly lower in the effective patients compared to thefailed patients（1289. 67±1 121. 83 vs 4 078. 60±2 578. 57,P〈0. 001）. In addition,the platelet transfusion efficiency in patients with a donor specific antibody misclassification number between 0 to 5 was higher than the patients with a donor specific antibody misclassification number 5（29. 38±22. 47 vs 18. 47±15. 38,P〉0. 05） withno statistically significant. Conclusion For PTR patients caused by HLA-class Ⅰ antibody,Eplets matching method need tobe applied with DSA MFI level data consideredto screen suitable platelet donor to ensure effectivetransfusion.

关 键 词：血小板输注无效 供者特异性抗体 表位 HLA-Ⅰ类抗体 荧光指数中值 

分 类 号：R457.11[医药卫生—治疗学] R446.62[医药卫生—临床医学]