造血干细胞移植儿童ABO血型不合对造血重建的影响和血型转换规律的变化  

Effect of ABO incompatibility on hematopoietic reconstruction in children undergoing hematopoietic stem cell transplantation and regular change of blood group conversion

作　　者：包旻翰 刘毅智 陈学军[1] 蒋钱 尹明伟 李晓雪[1] 徐军[1] 金小波[1] 徐晓军[3] BAO Minhan;LIU Yizhi;CHEN Xuejun;JIANG Qian;YIN Mingwei;LI Xiaoxue;XU Jun;JIN Xiaobo;XU Xiaojun(Department of Blood Transfusion,Children′s Hospital of Zhejiang University School of Medicine,National Clinical Medical Research Center for Children′s Health and Disease,Hangzhou 310052,China;Undergraduate of College of Medical Technology,Zhejiang Chinese Medical University;Department of Hematology,Children′s Hospital of Zhejiang University School of Medicine)

机构地区：[1]国家儿童健康与疾病临床医学研究中心浙江大学医学院附属儿童医院输血科,浙江杭州310052 [2]浙江中医药大学医学技术学院 [3]浙江大学医学院附属儿童医院血液科

出　　处：《中国输血杂志》2020年第10期1007-1012,共6页Chinese Journal of Blood Transfusion

摘　　要：目的分析造血干细胞移植(HSCT)儿童的ABO血型不合对造血重建的影响,观察其血型转换规律变化和移植后输血策略,保障移植患儿的科学合理、安全有效用血。方法回顾调查2018—2019年浙江大学医学院附属儿童医院30例患儿造血干细胞移植情况,将患儿分为ABO血型相合、ABO血型主要不相合、ABO血型次要不相合3组进行分析。通过血细胞临床指标的变化判断造血干细胞植活时间;根据移植后患儿血液中ABO血型抗原抗体的转化变化的不同来选择最优的成分血液输注。结果30例HSCT患儿中亲缘全相合3例(10%,3/30),亲缘半相合20例(66.67%,20/30),非亲缘脐血7例(23.33%,7/30)。ABO血型相合16例(53.33%,16/30),主要ABO血型不合7例(23.33%,7/30),次要ABO血型不合7例(23.33%,7/30)。30例HSCT患者全部获得造血重建。中性粒细胞植活天数(平均值±SD):ABO血型相合组(16人)为(14.75±5.20)d,主要血型不合组(7人)为(16.71±4.13)d,次要血型不合组(7人)为(15.29±1.98)d,各组间中性粒细胞植活时间无统计学差异(P>0.05)。血小板植活天数(平均值±SD):ABO血型相合组(16人)为(15.64±5.85)d,主要血型不合组(7人)为(22.43±11.17)d,次要血型不合组(7人)为(20.14±8.54)d,ABO血型相合组与次要不合组的血小板恢复时间无显著性差异(P>0.05),但ABO血型相合与主要不合组的差异具有统计学意义(P<0.05)。30例HSCT患儿移植后按AABB等输血策略选择成分血液输血,效果良好,无溶血性输血不良反应发生。结论HSCT儿童中供者HLA匹配选择以亲缘半相合为主。ABO血型相合与否对中性粒细胞植活时间无显著性影响;ABO血型相合组与次要不合组的血小板恢复时间差异无显著性,但血型相合与主要不合组的差异具有统计学意义。ABO血型相合儿童HSCT移植后首选ABO同型成分血液输注,ABO血型不相合儿童HSCT移植后应当根据受供者血型转换期的抗原抗体的不同选择配合的血液Objective To analyze the effect of ABO incompatibility on hematopoietic reconstruction in children undergoing hematopoietic stem cell transplantation(HSCT)and observe the regular change of blood group conversion as well as blood transfusion strategy after transplantation,in order to ensure the scientific,reasonable,safe and effective blood use of children after transplantation.Methods A retrospective investigation was conducted on 30 children with HSCT submitted to Children′s Hospital of Zhejiang University School of Medicine from 2018 to 2019.These children were divided into 3 groups:ABO compatibility group,major ABO incompatibility group and minor ABO incompatibility group.The time of hematopoietic reconstitution after HSCT was determined by the changes of clinical indexes of blood cells.The optimal blood component for transfusion was selected according to the transformation changes of ABO antigen/antibody in the blood after transplantation.Results Among the 30 children with HSCT,3 cases(10%,3/30)were related and completely HLA-matched,20(66.67%,20/30)were related and half HLA-matched(haplotype matched),and 7(23.33%,7/30)were unrelated cord blood.There were 16 cases(53.33%,16/30)of ABO compatibility,7(23.33%,7/30)of major ABO incompatibility,and 7(23.33%,7/30)of minor ABO incompatibility.All the 30 HSCT patients obtained hematopoietic reconstruction.Nneutrophil engraftment days(d)(mean±SD)were 14.75±5.20 for ABO compatibility group(16 children),16.71±4.13 for ABO major compatibility group(7 children),and 15.29±1.98 for ABO minor compatibility group(7 children).There was no statistically significant difference in the neutrophil engraftment days among the 3 groups(P>0.05).The platelet engraftment days(d)(mean±SD)were 15.64±5.85 in ABO compatibility group(16 children),22.43±11.17 in major compatibility blood group(7 children),and 20.14±8.54 in minor compatibility blood group(7 children).There was no significant difference in platelet recovery time between the ABO compatibility group and the minor ABO inc

关 键 词：造血干细胞移植 人类白细胞抗原 儿童 输血 血型 造血重建 

分 类 号：R457.11[医药卫生—治疗学] R725.7[医药卫生—临床医学]