免疫性血小板输注无效患者的人类白细胞抗原/人类血小板抗原抗体分布特征及其对交叉配型效果的影响  

The distribution characteristics of anti-human leukocyte antigen/anti-human platelet antigen antibodies and their influence on platelet cross-match in patients with immune platelet transfusion refractoriness

作　　者：敬媛媛[1] 王洁[1] 刘娜[1] 王东梅[1] 李冬妹[1] 贾延军[1] Jing Yuanyuan;Wang Jie;Liu Na;Wang Dongmei;Li Dongmei;Jia Yanjun(HLA Lab,Beijing Red Cross Blood Center,Beijing 100088,China)

机构地区：[1]北京市红十字血液中心HLA室,100088

出　　处：《北京医学》2022年第2期163-167,共5页Beijing Medical Journal

摘　　要：目的 分析影响免疫性血小板输注无效(platelet transfusion refractoriness, PTR)患者人类白细胞抗原(human leukocyte antigen, HLA)抗体和人类血小板抗原(human platelet antigen, HPA)抗体产生的因素,HLA和HPA抗体的分布特征、特异性及其对血小板交叉配型相合率的影响。方法 选取2019年1月至2020年12月因免疫性PTR于北京市红十字血液中心进行血小板抗体检测和交叉配型的患者910例,收集临床资料,采用酶联免疫吸附试验(enzyme linked immunosorbent assay, ELISA)检测其血清中的HLA抗体和HPA抗体,计算交叉配型患者的配血相合次数百分率和配血相合供者百分率以确定其找到相合供者的难易程度。结果 910例PTR患者中,HLA/HPA抗体的总体发生率为34.4%。女性(48.5%比22.2%)、生育史(52.0%比35.6%)和年龄偏大[(51.5±18.5)岁比(44.4±21.5)岁]是抗体发生的危险因素。不同疾病之间的抗体阳性率存在明显差异(P <0.001),急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的抗体发生率最低(15.2%),而骨髓增生异常综合征(myelodysplastic syndrome, MDS)的抗体发生率最高(51.9%)。在抗体阳性患者中,单一HLA抗体、单一HPA抗体和HLA+HPA抗体的发生率分别为67.1%、16.9%和16.0%。HPA抗体中最多的是针对糖蛋白GPⅡb/Ⅲa的抗体,占41.7%,其次为抗Ⅱb/Ⅲa+Ⅰa/Ⅱa的抗体(24.3%),有11.7%和7.8%的患者产生了针对Ⅰa/Ⅱa和Ⅰb/Ⅸ的抗体。单一HLA抗体阳性、HLA+HPA抗体阳性患者的配型相合次数百分率和配型相合供者百分率明显低于单一HPA抗体阳性患者。HLA抗体的强度与交叉配型相合次数百分率和配型相合供者百分率呈负相关,抗体水平越高,找到相合供者的难度越大。结论 女性、有生育史和年龄偏大将增加抗体发生的危险性。HLA抗体是导致免疫学PTR的主要因素,HLA抗体对交叉配血的影响高于HPA抗体,HLA抗体的强度对交叉配血也有负面影响。Objective To analyze the influence factors of the production of anti-human leukocyte antigen(HLA)and anti-human platelet antigen(HPA)in patients with immune platelet transfusion refractoriness(PTR),the distribution characteristics and specificity of HLA and HPA antibodies,as well as their influence on the compatibility rate of platelet crossmatch.Methods A total of 910 patients with immune PTR underwent platelet antibody detection and cross-matching in Beijing Red Cross Blood Center from January 2019 to December 2020 were selected.The clinical data of PTR patients were collected,and the HLA and HPA antibodies in their serum were detected by enzyme-linked immunosorbent assay(ELISA).The percentage of compatible cross-match and the percentage of compatible donors were calculated to evaluate the difficulty of finding compatible donors.Results In 910 PTR patients,the overall incidence of HLA and/or HPA antibodies was34.4%.Female(48.5%vs.22.2%),childbearing history(52.0%vs.35.6%)and age[(51.5±18.5)years vs.(44.4±21.5)years]were risk factors of antibody production.There was significant difference in antibody positive rate among different disease groups(P<0.001).The antibody incidence in acute lymphoblastic leukemia(ALL)was the lowest(15.2%),while that in myelodysplastic syndrome(MDS)was the highest(51.9%).Among antibody positive patients,the incidence of single HLA antibody,single HPA antibody and HLA+HPA antibody were 67.1%,16.9%and 16.0%respectively.Most of the HPA antibodies were against GPⅡb/Ⅲa,accounting for 41.7%,followed by anti-Ⅱb/Ⅲa+Ⅰa/Ⅱa(24.3%),11.7%and 7.8%patients produced antibodies againstⅠa/Ⅱa和Ⅰb/Ⅸ.The percentage of compatible cross-match and the percentage of compatible donors in patients with single HLA antibody and with HLA+HPA antibody were significantly lower than those in patients with single HPA antibody.The intensity of the HLA antibody was negatively correlated with the percentage of cross match times and match donors.The higher the level of HLA antibody,the more difficult

关 键 词：血小板输注无效 人类白细胞抗原抗体 人类血小板抗原抗体 血小板交叉配型 

分 类 号：R457.1[医药卫生—治疗学]