单中心输血前患者意外抗体筛查结果分析  

Analysis of unexpected antibody screening in patients before blood transfusion in a medical center

作　　者：李楠 李归宁 甘蕾 李坚 鲁学良 陈凤花[1] LI Nan;LI Guining;GAN Lei;LI Jian;LU Xueliang;CHEN Fenghua(Department of Transfusion Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院输血科,武汉430022

出　　处：《临床血液学杂志》2023年第4期230-234,共5页Journal of Clinical Hematology

摘　　要：目的:分析单中心患者输血前血浆中意外抗体筛查阳性率和分布情况。方法:统计2016—2020年意外抗体筛查人次及其阳性病例,并随机抽取同一时段意外抗体筛查阴性病例,通过回顾性病例对照研究分析意外抗体筛查阳性率在不同性别、输血史和妊娠史以及不同疾病中的分布情况,同时对意外抗体的消逝和持续性进行分析。结果:调查时间段内进行意外抗体筛查219386人次,其中1488人次为阳性,阳性率为0.68%;选取意外抗体阳性的1147例患者作为观察组,随机抽取同时段意外抗体筛查阴性的1159例患者作为对照组,单因素分析显示,意外抗体阳性率在性别、输血史、血液疾病、自身免疫性疾病、肿瘤、肝脏疾病、心脏疾病等方面,差异有统计学意义(P<0.05);多因素分析显示输血史、血液疾病、自身免疫性疾病和肝脏疾病为意外抗体产生的影响因素(P<0.05);1147例意外抗体筛查阳性患者中42例转变为阴性,消逝率为3.66%(42/1147);意外抗体消逝率在血液疾病患者中显著高于非血液疾病(P<0.05);消逝的中位时间为109 d。结论:有输血史、血液疾病、自身免疫性疾病和肝脏疾病患者产生意外抗体的风险较高,建议此类患者在输血期间增加抗体筛查的频率;随着抗体的消逝,输血风险增加,建议为曾经检出过意外抗体的患者建立同种免疫档案,保证输血安全。Objective To analyze the prevalence and distribution of unexpected antibody screening in patients before blood transfusion in a medical center.Methods The number of unexpected antibody screening cases and their positive cases in our hospital from 2016 to 2020 was counted,and the negative cases of unexpected antibody screening were randomly selected during the same period.A retrospective case-control study was conducted to analyze the prevalence and distribution of unexpected antibody screening among the patients with several clinical conditions including different genders,the history of blood transfusion and pregnancy,and different diseases.The evanescence and persistence of these positive unexpected antibodies were analyzed at the same time.Results Among a total of 219386 cases,1488 cases(0.68%)had positive results for unexpected antibody screening tests during the investigation period.1147 patients who were positive for unexpected antibodies were selected as the observation group,and 1159 patients with negative unexpected antibodies screening in the same period were randomly selected as the control group.Univariate analysis showed that there were statistically significant differences in the positive rate of unexpected antibody screening among the patients with different genders,the history of blood transfusion,blood diseases,autoimmune diseases,tumors,liver diseases and heart diseases(P<0.05).Multivariate analysis showed that the history of blood transfusion and blood diseases,autoimmune diseases and liver diseases were the influencing factors of unexpected antibody positivity(P<0.05).The tested results from 42 patients with positive unexpected antibodies screening turned negative,and the evanescence rate of unexpected antibodies was 3.66%(42/1147).The evanescence rate of unexpected antibodies was significantly higher in the patients with blood disorders than those with non-blood disorders(P<0.05).The median days of the evanescence of unexpected antibodies was 109.Conclusion Patients with several clinical condi

关 键 词：意外抗体 抗体筛查 同种免疫 消逝 输血安全 溶血性输血反应 

分 类 号：R457.1[医药卫生—治疗学]