DAT试管法阴性而微柱凝胶法阳性的原发自身免疫性溶血性贫血患者的临床与实验室特征  

Clinical and Laboratory Characteristics of Primary Autoimmune Hemolytic Anemia Patients with Negative Results of DAT by Tube Test But Positive Results by Microcolumn Gel Assay

作　　者：王朝 周雪丽 薄丽津 徐艳 刘慧娟 赵玉平 WANG Zhao;ZHOU Xue-Li;BO Li-Jin;XU Yan;LIU Hui-Juan;ZHAO Yu-Ping(Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Tianjin 300020,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,天津300020

出　　处：《中国实验血液学杂志》2022年第5期1532-1535,共4页Journal of Experimental Hematology

摘　　要：目的:探讨直接抗人球蛋白试验(DAT)试管法阴性而微柱凝胶法阳性的原发自身免疫性溶血性贫血(AIHA)患者的临床与实验室特征,为此类患者的诊断提供借鉴。方法:回顾性分析2015年1月至2020年12月在本院就诊的原发AIHA患者59例。根据DAT试管法和微柱凝胶法结果将研究对象分为3组,比较各组的临床与实验室特征。结果:将研究对象分为DAT两方法均阴性组(Ⅰ组,n=5)、DAT试管法阴性而微柱凝胶法阳性组(Ⅱ组,n=26)、DAT两方法均阳性组(Ⅲ组,n=28)。Ⅱ组与其他组别相比,年龄、性别组成均无显著差异,DAT微柱凝胶法抗IgG+抗C3d阳性比例低于Ⅲ组(P=0.015)。Ⅱ组临床表现以胸闷、憋气、乏力等贫血相关症状以及皮肤、巩膜黄染或尿色加深等溶血相关症状为主,但发生率与其他组别无显著差异。Ⅱ组的红细胞数(RBC)、血红蛋白(Hb)等贫血相关指标低于参考范围,但与Ⅰ组、Ⅲ组相比差异无统计学意义。Ⅱ组的网织红细胞(Ret)比率、间接胆红素(IBIL)、乳酸脱氢酶(LDH)、游离血红蛋白(F-Hb)等溶血相关指标高于参考范围,其中后2项显著高于Ⅰ组(P=0.031和P=0.036)。Ⅱ组的血清补体C3、C4水平均高于Ⅲ组(P=0.010和P=0.037)。结论:DAT试管法阴性而微柱凝胶法阳性的原发AIHA患者与两方法均阴性和均阳性患者相比,贫血程度接近,但补体系统参与溶血的机制和程度可能不同。这一结果可能对此类患者的实验室诊断与鉴别提供帮助。Objective: To investigate the clinical features and laboratory characteristics of primary autoimmune hemolytic anemia(AIHA) patients with negative results of direct antiglobulin test(DAT) by tube test but positive results by microcolumn gel assay, in order to provide references for the diagnosis of these patients. Methods: 59 patients diagnosed with primary AIHA in our hospital from January 2015 to December 2020 were retrospectively analyzed.According to the results of tube test and microcolumn gel assay, the cases were divided into 3 groups, and the clinical and laboratory characteristics of each group were compared. Results: The cases were grouped as follows: Group Ⅰ, cases with negative results by both methods of DAT(n=5);Group Ⅱ, cases with negative results by tube test but positive results by microcolumn gel assay(n=26);Group Ⅲ, cases with positive results by both methods of DAT(n=28). There was no significant difference in age and sex between Group Ⅱ and other groups, whereas the positive rate of anti-IgG + anti-C3d of Group Ⅱ was lower than that in Group Ⅲ(P=0.015). The main clinical manifestations of Group Ⅱ were chest tightness,shortness of breath, fatigue, as well as yellow skin and sclera or dark urine, but the incidence rate of these symptoms was not significantly different from other groups. Anemia related indexes in Group Ⅱ such as red blood cell(RBC) count and hemoglobin(Hb) were lower than the reference intervals, but there was no significant difference compared with other groups. Hemolysis related indexes in Group Ⅱ such as reticulocyte(Ret) ratio, indirect bilirubin(IBIL), lactate dehydrogenase(LDH) and free-hemoglobin(F-Hb) were higher than the reference intervals, and the latter two items were signficantly higher than those in Group Ⅰ(P=0.031 and P=0.036). Serum complement C3 and C4 in Group Ⅱ were higher than those in Group Ⅲ(P=0.010 and P=0.037). Conclusion: Anemia severity of primary AIHA patients who were negative of DAT by tube test but positive by microcolumn gel

关 键 词：自身免疫性溶血性贫血 直接抗人球蛋白试验 微柱凝胶法 临床特征 实验室特征 

分 类 号：R556.6[医药卫生—血液循环系统疾病]