流式细胞微珠法检测血小板输注无效患者血小板同种抗体及临床应用  

Clinical application of flow cytometric bead assay in detecting isoimmunization antibodies in platelet transfusion refractoriness patients

作　　者：刘文宾[1] 胡慧瑾[1] 吴迪炯[1] 俞庆宏[1] 沈一平[1] 李秋爽 叶宝东[1] LIU Wen-bin;HU Hui-jin;WU Di-jiong(Department of Hematology,the First Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou,Zhejiang 310006,China)

机构地区：[1]浙江中医药大学附属第一医院血液科,浙江杭州310006 [2]浙江中医药大学附属第一医院临床评价分析中心

出　　处：《中华全科医学》2018年第11期1793-1795,1799,共4页Chinese Journal of General Practice

基　　金：浙江省中医药管理局青年人才基金(2015ZQ013);浙江省中医药管理局基金项目(2017ZB034);浙江省教育厅科研基金项目(Y201636810)

摘　　要：目的评价单抗原微珠抗体检测免疫性血小板输注无效(IPR)的诊断价值,以及对IPR和非免疫性PR(NIPR)的鉴别诊断价值。方法建立检测抗HLA-Ⅰ抗体和抗HLA-Ⅱ抗体流式细胞微珠法,借以检测浙江中医药大学附属第一医院107例输注血小板的血液病患者,其中IPR患者29例,NIPR患者26例和NPR(血小板正常反应性)患者52例,客观评价该试验在IPR诊断中的敏感性和特异性,并分析与24 h CCI(corrected count increment,校正计数增殖)的相关性。结果 55例PR患者的HLA抗体阳性率为52. 73%;IPR组抗HLA抗体总阳性率为100. 0%,与NIPR组患者(0. 0%)和NPR组患者(13. 46%)比较,差异均有统计学意义(均P <0. 01);抗HLA-Ⅰ和抗HLA-Ⅱ诊断IPR的敏感性分比为89. 66%、55. 17%,特异性分别为85. 71%、14. 29%,阳性预测值分别为96. 30%、72. 72%,阴性预测值分别为66. 67%、7. 14%,总有效率分别为90. 82%、34. 73%;抗HLA-Ⅰ、抗HLA-Ⅱ抗体水平[吸光度(A值)]与24 h CCI均呈负相关(r=-0. 594,P <0. 05;r=-0. 525,P <0. 05)。结论单抗原微珠抗体检测抗HLA-Ⅰ抗体具有较高特异性,对IPR患者具有较高诊断价值,可作为IPR和NIPR的鉴别诊断依据。Objective To evaluate the clinical significance of flow cytometric bead assay （FCBA） test in diagnosis of immune-mediated platelet refractoriness （IPR） and in the differential diagnosis of IPR from non-immune mediated platelet refractoriness （NIPR）. Methods FCBA was established and used to detect the HLA- Ⅰ and HLA-Ⅱ antibody of 107 patients with hematopathy who relied on platelet transfusion. There were 29 patients of IPR, 26 patients of NIPR and 52 patients of NPR. The sensitivity and specificity of the approach for the diagnosis of IPR were evaluated, and the correlation between the levels of anti-HLA- Ⅰ / HLA- Ⅱ and 24 h corrected count increment （CCI） were analyzed. Results The positive percentage of 55 PR patients＇ HLA antibodies was 52.73%. The total positive rate of HLA antibodies in IPR group was 100%, which compared with the positive percentage of NIPR group （0.0%） and NPR group （13.46%） both had significant statistical difference（ all P 〈 0.01 ）. The results showed that for the diagnosis of IPR, anti- HLA- Ⅰ and HLA-Ⅱ had the sensitivity of 89.66% and 55.17%, the specificity of 85.71% and 14.29%, the positive predictive value of 96.30% and 72.72%, the negative predictive value of 66.67% and 7.14% , and the total efficiency of 90.82% and 34.73% , respectively. The concentration of anti-HLA-Ⅰ and anti-HLA- Ⅱ antibody both was negatively correlated with 24 h CCI（r= -0.594, P〈0.05; r= -0.525, P〈0.05）. Conclusion Flow Cytometrie Bead assay in detecting HLA- Ⅰ antibody has high specificity, and it is proved to be of great value for the diagnosis of IPR and for differential diagnosis of IPR from NIPR.

关 键 词：血小板输注无效 免疫性 校正计数增殖 

分 类 号：R457.1[医药卫生—治疗学]