人类白细胞抗原-A33、-B58抗体介导的新生儿同种免疫性血小板减少症并文献复习  

Neonatal alloimmune thrombocytopenia caused by HLA-A33 and-B58 antibodies:a case report and literature review

作　　者：李恒聪 周燕 李丽兰 钟周琳 卢芳 吴国光 Li Hengcong;Zhou Yan;Li Lilan;Zhong Zhoulin;Lu Fang;Wu Guoguang(Nanning Institute of Transfusion Medicine,Nanning Blood Center,Nanning 530007,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]南宁输血医学研究所南宁中心血站,南宁530007

出　　处：《国际输血及血液学杂志》2022年第1期42-50,共9页International Journal of Blood Transfusion and Hematology

基　　金：广西科学研究与技术开发计划项目(08160-05、桂科攻1355005-2-4);广西自然科学基金(2017GXNSFAA198240、2016GXNSFAA380144、2016GXNSFAA380143);南宁市科学研究与技术开发计划项目(20173117);广西医学高层次骨干人才培养"139"计划培养项目(G201903046);南宁市医学重点学科建设项目。

摘　　要：目的探讨人类白细胞抗原(HLA)抗体介导新生儿同种免疫性血小板减少症(NAIT)患儿的实验室检测和临床诊治经过,并进行相关文献复习。方法选择2019年4月25日,广西壮族自治区妇幼保健院收治的1例日龄为29 d的男性NAIT新生儿为研究对象。采用回顾性研究方法,收集该例患儿的临床病例资料,并对其病史、相关实验室检查和基因检测结果进行分析。以"新生儿同种免疫性血小板减少症""人类白细胞抗原""neonatal alloimmune thrombocytopenia""human leukocyte antigen""HLA"为关键词,在中国知网数据库、万方数据服务知识平台、PubMed数据库中检索HLA抗体介导NAIT的相关文献。检索时间设定为以上数据库建库至2021年9月22日。分析并总结纳入文献所报道的介导NAIT的HLA抗体特异性。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①病史采集:患儿因"血小板减少致全身淤点、淤斑"于2019年3月30日被送至广西壮族自治区妇幼保健院就诊,头颅CT检查结果证实患儿颅内出血。②主要血清学检测:患儿及其母亲ABO血型均为A型,父亲为AB型;三者CD36抗原均呈阳性。患儿母亲血清标本中检出HLA抗体,特异性为HLA-A33、-B58。③相关基因检测:患儿及其父母的人类血小板抗原(HPA)-1~21bw基因分型分别为HPA-1aa/2aa/3bb/4~14aa/15aa/16~21aa、HPA-1aa/2aa/3ab/4~14aa/15ab/1621aa、HPA-1aa/2aa/3ab/4~14aa/15ab/16~21aa;HLA基因分型分别为HLA-A*11:01,33:03;B*38:02,58:01、HLA-A*24:02,33:03;B*55:02,58:01、HLA-A*11:01,11:01;B*15:02,38:02。④诊断及输血治疗:根据实验室检查结果及临床表现,本例患儿被诊断为HLA-A33、-B58抗体介导NAIT。患儿接受30 mL配合性血小板输注24 h后,血小板计数由13×109/L上升至100×109/L,出血症状明显改善。⑤文献复习结果:符合本研究要求的文献为25篇,纳入研究的HLA抗体介导NAIT患儿为45例。其中,由HLA抗体、HLA+HPA抗体、HLA+�Objective To investigate the laboratory detection,clinical diagnosis and treatment of newborn with neonatal alloimmune thrombocytopenia(NAIT)caused by human leukocyte antigen(HLA)antibodies,and review related literature.Methods on April 25,2019,one 29-day-old male newborn with NAIT who was admitted to Maternity and Child Health Care of Guangxi Zhuang Autonomous Region was selected as the research subject.The clinical data of this case were collected by retrospective analysis,and the medical history,related laboratory examination and genetic test results were analyzed.With"neonatal alloimmune thrombocytopenia","human leukocyte antigen"and"HLA"as the key words in Chinese and English,China National Knowledge Infrastructure database,Wanfang Data Knowledge Service Platform,PubMed database were searched for related literature about NAIT caused by HLA antibodies in this study.Retrieval time was from the above database inception to September 22,2021.The specific characteristics and diagnostic methods of NAIT caused by antibodies were analyzed and summarized.This study meets the requirements of the World Medical Association Declaration of Helsinki revised in 2013.Results①Medical history of the newborn was as follows.In March 30,2019,the newborn was admitted to Maternity and Child Health Care of Guangxi Zhuang Autonomous Region due to systemic stasis and ecchymosis caused by thrombocytopenia.The results of skull CT confirmed the newborn with intracranial hemorrhage.②Main laboratory tests results showed that ABO blood type of both the newborn and his mother was A group,and his father was AB group,and all of them were positive for CD36 antigen.HLA-A33 and-B58 antibodies in serum sample of the mother was detected.③Genetic test results showed that the HPA genotype of the newborn and his father and mother were HPA-1aa/2aa/3bb/4-14aa/15aa/16-21aa,HPA-1aa/2aa/3ab/4-14aa/15ab/16-21aa and HPA-1aa/2aa/3ab/4-14aa/15ab/16-21aa,respectively.The HLA genotype of them were HLA-A*11:01,33:03;B*38:02,58:01,HLA-A*24:02,33:03;B*55:02,58

关 键 词：HLA抗原 同种抗体 血小板减少 新生儿同种免疫性 血清学试验 分子诊断技术 

分 类 号：R722.1[医药卫生—儿科]