部队采供血机构无偿献血者血液检测策略研究  

Optimization of blood testing strategies for voluntary blood donors in military blood centers

作　　者：冯丽梅[1] 张婷[1] FEGN Limei;ZHANG Ting(Department of Blood Transfusion,PLA Clinical Blood Transfusion Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心输血医学科解放军临床输血中心,北京100853

出　　处：《中国输血杂志》2022年第8期828-832,共5页Chinese Journal of Blood Transfusion

摘　　要：目的探讨部队采供血机构无偿献血者血液检测策略的优化。方法从本中心输血管理系统中收集2017年1月~2020年12月无偿献血者血清学5项检测指标数据,回顾性统计分析在本中心献血的无偿献血者血液血清学检测5项指标的不合格情况(历年的不合格率、军/民献血者不合格比例、ELISA双试剂或单试剂检测输血传播病原体反应性比例等)与核酸检测HBV、HCV、HIV不合格情况。结果本中心2017年~2020年军人/地方献血者比例为1∶4(25817/102067);献血者血液检测指标总不合格率为3.34%(4269/127884),各项指标不合格率依次为ALT>HBsAg>抗-TP>抗-HCV>HIV抗原/抗-HIV>NAT,其中军人献血者相应为3.5%(905/25817)、ALT>抗-HCV>HBsAg>HIV抗原/抗-HIV>抗-TP>NAT,地方献血者为3.3%(3367/102067)、HBsAg>抗-TP>ALT>抗-HCV>HIV抗原/抗-HIV>NAT(P<0.01);4年间本中心无偿献血者血液检测不合格率HBsAg、抗-HCV和抗-TP逐年下降,HIV抗原/抗-HIV有所起伏,ALT则逐年递增(均为P<0.01);军人献血者的ALT不合格率最高[2.3%(594/25817)],占整个军人献血者血液检测不合格率的65.85%(594/902)。本组献血者的HBsAg、抗-HCV、HIV抗原/抗-HIV和抗-TP ELISA双试剂不合格比例分别为72.87%(787/1080)、33.02%(173/524)、16.56%(80/483)、67.67%(584/863)(P<0.05)。4年间ELISA检测阴性的献血者标本经NAT检测HBV DNA(+)比例为0.045‰(56/123668),军人献血者为0.02‰(3/123668)。结论部队采供血机构现行血液筛查策略基本保障了临床用血安全;其血液报废的主因是高于ALT检测临界值的军人献血者比例较高;强化核酸检测的推广、落实,有针对性地调整个别检测指标的临界值,对于降低输血传播疾病风险并减少血源浪费,从而提升部队临床供血的安全性与保障水平,促进官兵救治能力,乃至提高部队战斗力都有积极意义。Objective To explore the optimization of blood testing strategies for voluntary blood donors in military blood centers.Methods From January 2017 to December 2020,the testing results of five serological indicators of voluntary blood donors from our center were collected via the blood transfusion management system.The positive NAT results of HBV,HCV and HIV,as well as the unqualified serological indicators,including the unqualified rate over the years,unqualified rate of military/civilian blood donor,reactive rate of dual-ELISA-reagent or one-ELISA-reagent etc.,were retrospectively analyzed.Results The ratio of military blood donors to civilian blood donors in our center was 1:4 during 2017~2020.The total unqualified rate of blood testing indicators of military blood donors was ALT>anti-HCV>HBsAg>HIV antigen/anti-HIV>anti-TP>NAT,and that of civilian blood donors was HBsAg>anti-TP>ALT>anti-HCV>HIV antigen/anti-HIV>NAT.The total unqualified rate of HBsAg,anti-HCV and anti-TP in our center decreased year by year,the HIV antigen/anti-HIV fluctuated,and the ALT increased year by year(P<0.01).The ALT deferral rate among military blood donors was the highest,accounting for 65.85%(594/902)of the donation deferral.The reactive rate of dual-ELISA-reagent to HBsAg,anti-HCV,HIV antigen/anti-HIV and anti-TP in civilian blood donors were 72.87%,33.02%,16.56%and 67.67%,respectively(P<0.05).Among the 123668 ELISA negative samples during 2017~2020,56 cases of HBV DNA(+)were detected by NAT,including 3 cases of military blood donors.Conclusion The current blood screening strategy of military blood centers can basically guarantee the safety of blood use in clinical.For military blood donors,ALT deferral,caused by ALT results that are higher than the ALT threshold,was the main reason for blood scrapping.Strengthening the promotion and implementation of NAT,as well as adjusting the critical value of ALT is of positive significance for reducing the risk of blood transfusion-transmitted diseases and the waste of blood sources,thereby imp

关 键 词：部队采供血机构 无偿献血者 军人献血者 血液检测策略 血液安全 输血传播 

分 类 号：R446.6[医药卫生—诊断学] R193.3[医药卫生—临床医学]