免疫性血小板输注无效对恶性血液病异基因造血干细胞移植患者的影响  

The Effect of Immunized Platelet Transfusion Refractoriness on Allo-HSCT Patients with Malignant Hematological Diseases

作　　者：左元玲[1] 翟菊萍[1] 李勇[1] 蒋敏[1] 崔庆亚[2] 唐晓文[2] 赵益明[3] 张建明 ZUO Yuan-Ling;ZHAI Ju-Ping;LI Yong;JIANG Min;CUI Qing-Ya;TANG Xiao-Wen;ZHAO Yi-Ming;ZHANG Jian-Ming(Department of Blood Transfusion,The First Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu Province,China;Department of Hematology,The First Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu Province,China;Jiangsu Institute of Hematology,The First Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu Province,China;Department of Clinical Laboratory,Suzhou Municipal Hospital,Suzhou 215002,Jiangsu Province,China)

机构地区：[1]苏州大学附属第一医院输血科,江苏苏州215000 [2]苏州大学附属第一医院血液科,江苏苏州215000 [3]苏州大学附属第一医院江苏省血液研究所,江苏苏州215000 [4]苏州市立医院检验科,江苏苏州215002

出　　处：《中国实验血液学杂志》2021年第6期1923-1928,共6页Journal of Experimental Hematology

基　　金：国家自然科学基金(81873431);江苏省自然科学基金(BK20181164)。

摘　　要：目的:探讨血小板抗体在血液病患者中产生的特点,研究免疫性血小板输注无效对恶性血液病异基因造血干细胞移植(allo-HSCT)患者临床预后的影响。方法:回顾性分析2014年7月1日-2019年7月1日苏州大学附属第一医院利用Capture-P方法鉴定血小板抗体阳性患者的性别、年龄、疾病、血小板输注、CD34;细胞数和移植预后等临床资料。结果:5年内,共有913例血小板抗体鉴定阳性血液病患者(7.28%),女性(513例)多于男性(400例),其中520例恶性血液病(急性髓细胞白血病、急性淋巴细胞白血病和骨髓增生异常综合征)患者抗体阳性率(10.27%、8.01%和7.20%)明显不同(P<0.01),急性髓系白血病患者的抗体阳性率高于骨髓增生异常综合征的(α<0.0125)。移植前共有35例免疫性血小板输注无效患者,其血小板增加数、14 h校正血小板增高指数、无进展生存率和总生存率明显低于阴性输注有效组(P<0.01),而ABO全相合比例明显高于阴性输注有效组(α<0.0125)。结论:女性和急性髓系白血病患者血小板抗体鉴定阳性率高,由抗体引起的免疫性血小板输注无效是引起恶性血液病患者allo-HSCT预后不良的风险因素。Objective: To investigate the characteristics of platelet antibody in patients with hematological diseases,so as to research the effect of immunized platelet transfusion refractoriness( PTR) on the prognosis of allogeneic hematopoietic stem cell transplantation( allo-HSCT) recepients with malignant hematological diseases patients.Methods: The clinical data of platelet antibody positive patients tested by Capture-P in the First Affiliated Hospital of Soochow University from July 1,2014 to July 1,2019 were retrospectively analyzed,including sex,age,disease,platelet transfusion assessments,CD34;cells,transplant prognosis,and so on. Results: In 5 years,913( 7. 28%)hematologic patients with platelet antibody positive were identified,the detection rate of females( 513 cases) were higher than males( 400 cases). Among the 913 patients, the antibody positive rates of 520 patients with malignant hematological diseases( acute myeloid leukemia,acute lymphoblastic leukemia and myelodysplastic syndrome) showed significantly statistical different( 10.27%,8.01%,and 7.20%)( P<0.01),and the positive rate of the acute myeloid leukemia of those patients was higher than myelodysplastic syndrome patients( α < 0. 0125). There were 35 cases diagnosed as immunized PTR before allo-HSCT,the platelet increments,14 h correct count increment,progression-free survival rate and overall survival rate of those patients were significantly lower than those in negative transfusion effective patients( P<0. 01),while the percentage of ABO matching was significantly higher( α< 0.0125). Conclusion: The positive rate of platelet antibody identification is high in females and acute myeloid leukemia patients,and immunized PTR caused by antibody is a risk factor for poor prognosis of allo-HSCT in malignant hematological disease patients.

关 键 词：血小板抗体 免疫性血小板输注无效 恶性血液病 异基因造血干细胞移植 预后 

分 类 号：R457.7[医药卫生—治疗学] R733[医药卫生—临床医学]