免疫性血小板输注无效患者交叉配合输注的研究  

Research on Platelet Antibody Screening and Crossmatch in Patients with Immune Platelet Transfusion Refractoriness

作　　者：杨冬梅[1] 程福 陈春霞[1] 魏曾珍[1] 鄢玲利 黄春妍[1] 秦莉[1] YANG Dongmei;CHENG Fu;CHEN Chunxia;WEI Zengzhen;YAN Lingli;HUANG Chunyan;QIN Li(Department of Transfusion Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院输血科,四川成都610041

出　　处：《标记免疫分析与临床》2022年第4期554-559,617,共7页Labeled Immunoassays and Clinical Medicine

基　　金：四川省科技计划项目(编号:2021YJ0454)。

摘　　要：目的通过比较不同血小板输注策略的输注疗效,探讨血小板抗体筛查及交叉配型对于免疫性血小板输注无效(platelet transfusion refractoriness,PTR)患者的应用价值。方法采用固相凝集法对临床送检血小板抗体筛查的患者进行血小板抗体检测,提取患者的临床资料如性别、年龄、疾病种类、输血记录等,计算血小板抗体筛查阳性率并分析其分布特点。以血小板输注后增量(the post-transfusion platelet increment,PPI)和血小板校正后增值(the corrected count increment,CCI)为衡量指标,分析比较血小板抗体阳性以及不同输血策略(随机输注、交叉相合、交叉不相合)对患者血小板输注疗效的影响。结果血小板抗体筛查阳性患者61例(23.55%),且多为血液系统疾病患者;其中,抗体筛查阳性组的PPI(U=18851,P=0.0720)、CCI(U=14585,P=0.0183)、血小板输注有效率(χ^(2)=5.691,P=0.017)均低于抗体筛查阴性组。61例抗体阳性患者先后共输注122次血小板,其中,交叉相合73次,交叉不相合6次,随机输注43次;交叉相合组的PPI(11 vs 4,P<0.001)、CCI(6.7 vs 0,P=0.001)中位数均明显高于随机输注组(P<0.001),且血小板输注有效率高于随机输注组(58.6%vs 24.4%,χ^(2)=12.163,P=0.001)。对于血小板抗体阳性的血液病患者,交叉相合组的PPI(13.5 vs 0,P=0.025)、CCI(9.0 vs 0,P=0.001)中位数高于随机输注组,且血小板输注有效率高于随机输注组(60.7%vs 29.2%,χ^(2)=5.175,P=0.023)。交叉不相合组与其余两组之间的差异无统计学意义。结论临床有必要常规检测血小板抗体,且为患者提供交叉配血相合的血小板可以显著提高其血小板的输注疗效。Objective To explore the application value of platelet antibody screening and crossmatch in improving the efficacy of platelet transfusion in patients with immune platelet transfusion refractoriness(PTR),by analyzing the efficacy and significance of different platelet transfusion strategies.Methods Solid phase agglutination method was used to detect platelet antibody in patients undergone platelet antibody screening.The clinical data of selected patients,such as gender,age,types of disease and transfusion records,were extracted.The positive rate of platelet antibody screening was calculated,and its distribution characteristics were analyzed.The post-transfusion platelet increment(PPI)and the corrected count increment(CCI)were used as indexes for analyzing the effect of platelet antibody and different transfusion strategies(random transfusion,cross-matched group and cross-mismatched group)on platelet transfusion.Results There were 61(23.55%)patients positive of platelet antibody screening and most of them were patients with hematological diseases.PPI(U=18851,P=0.0720),CCI(U=14585,P=0.0183)and the effective rate of platelet transfusion(χ^(2)=5.691,P<0.05)in the antibody screening positive group were lower,compared to those in the antibody screening negative group.A total of 122 transfusions were recorded of the 61 patients with platelet antibody,including 73 transfusions of cross-matched,6 transfusions of cross-unmatched and 43 transfusions of random;The median PPI,median CCI and effective rate of platelet transfusion of the cross-matched group were both higher than those of the random transfusion group(median 11 vs 4,P<0.001;median 6.7 vs 0,P=0.001;58.6%vs 24.4%,χ^(2)=12.163,P=0.001,respectively).For hematological diseases patients with platelet antibodies,the median PPI,median CCI,effective rate of platelet transfusion of the cross-matched group were also both higher than that of the random infusion group(median 13.5 vs 0,P=0.025;median 9.0 vs 0,P=0.001;60.7%vs 29.2%,χ^(2)=12.163,P=0.023,respectively).There wa

关 键 词：血小板输注无效 血小板抗体筛查 血小板交叉配型 

分 类 号：R457.1[医药卫生—治疗学]