直接抗人球蛋白试验阳性强度对患者红细胞输注效果的影响  

Study on the effect of direct anti-human globulin test positive strength on patients′red blood cell transfusion

作　　者：陈麟凤 庄健美 张金荣 刘璇 张蕾 鄢丹 Chen Linfeng;Zhuang Jianmei;Zhang Jinrong;Liu Xuan;Zhang Lei;Yan Dan(Department of Blood Transfusion,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Beijing Key Laboratory of Bio-characteristic Profiling for Evaluation of Rational Drug Use,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院输血科,北京100038 [2]临床合理用药生物特征谱学评价北京市重点实验室,北京100038

出　　处：《中华医学杂志》2020年第44期3510-3514,共5页National Medical Journal of China

基　　金：临床合理用药生物特征谱学评价北京市重点实验室开放研究课题(2018KF04)。

摘　　要：目的:探讨患者直接抗球蛋白试验(DAT)阳性强度对红细胞输注效果的影响。方法:收集2015年1月至2019年3月于首都医科大学附属北京世纪坛医院输血科行DAT检测的患者输血相容性检测和临床输血资料,采用回顾性队列研究方法分析DAT阳性强度与患者配血结果、不规则抗体检测结果、输血后胆红素值、红细胞输注效果的相关性。结果:从配血检测结果来看,次侧配血结果与DAT强度显著相关(r=0.58,P<0.01)。抗筛阳性患者DAT阳性强度更高(χ^2=126.810,P<0.01)。DAT阳性强度对患者直接胆红素值有影响,DAT阳性强度越高,患者直接胆红素越高(χ^2=32.069,P<0.01);且对患者总胆红素值也有影响(χ^2=17.981,P=0.001)。从红细胞输注效果来看,DAT阳性强度为0.5患者输注有效率较低(28.6%),其余患者DAT阳性强度与红细胞输注效果无关,不同DAT阳性强度(1、2、3、4)患者输血有效率分别为57.0%、60.1%、65.6%和60.0%,同一DAT阳性强度下,患者的输血有效率较高(χ^2=41.071,P=0.009)。结论:不同DAT阳性强度与患者次侧配血结果、直接胆红素含量存在相关性,而红细胞输注效果与DAT阳性强度没有显著关联。但DAT阳性强度增加,患者出现不规则抗体几率增大。Objective To investigate the effect of direct antiglobulin test(DAT)positive strength on the clinical effect of red blood cell transfusion.Methods The clinical data was collected on blood transfusion compatibility test and clinical transfusion of patients who underwent DAT testing from January 2015 to March 2019 in the Department of Blood Transfusion,Beijing Shijitan Hospital affiliated to Capital Medical University.A retrospective cohort study method was used to analyze the correlation between the DAT positive strength and the blood match results,irregular antibody test results,bilirubin value after blood transfusion,and red blood cell transfusion effect.Results According to the blood matching test results,the minor cross-matching results were significantly correlated with the DAT strength(r=0.58,P<0.01).The DAT strength of the antibody-screening positive patients was greater(χ^2=126.810,P<0.01).DAT-positive strength influences the direct bilirubin,the higher the DAT-positive strength,the higher the direct bilirubin concentration of the patients(χ^2=32.069,P<0.01).DAT-positive strength also had an effect on patients′total bilirubin value(χ^2=17.981,P=0.001).From the effect of red blood cell transfusion,patients with a DAT positive strength of 0.5 had a lower effective rate of transfusion(28.6%).The remaining DAT strength had no relation to the effect of red blood cell transfusion,and the efficiency of blood transfusion in patients with different DAT-positive strengths(1,2,3,4)was 57.0%,60.1%,65.6%and 60.0%,respectively.With the same DAT strength,the patient′s transfusion efficiency was higher(χ^2=41.071,P=0.009).Conclusion Different DAT-positive strengths are correlated with the patient′s minor cross-match results and bilirubin content,while the effect of red blood cell transfusion has no significant correlation with DAT-positive strength.However,with the increase of DAT positive strength,patients are more likely to have irregular antibodies.

关 键 词：血液成分输血 红细胞 次侧配血 直接抗人球蛋白试验 阳性强度 

分 类 号：R457.1[医药卫生—治疗学]