因HLA和CD36复合抗体致血小板输注无效患者的配型策略  

Matching strategy for patients with platelet transfusion refractoriness caused by compound antibodies against HLA and CD36

作　　者：邓晶[1] 徐秀章[1] 钟慧斌 钟笔 陈扬凯[1] 刘静[1] 丁浩强[1] 夏文杰[1] 陈大伟[1] 许耀日 叶欣[1] DENG Jing;XU Xiuzhang;ZHONG Huibin;ZHONG Bi;CHEN Yangkai;LIU Jing;DING Haoqiang;XIA Wenjie;CHEN Dawei;XU Yaori;YE Xin(Institute of Blood Transfusion,Guangzhou Blood Center,Guangzhou 510095,China)

机构地区：[1]广州血液中心临床输血研究所,广东广州510095

出　　处：《中国输血杂志》2023年第6期463-466,共4页Chinese Journal of Blood Transfusion

基　　金：2023年度市校(院)企联合资助专题(2023A03J0549);广东省自然科学基金(2022A1515012096);广州市科技计划项目(202201011749);广州市医学重点学科(2021-2023)。

摘　　要：目的为HLA和CD36复合抗体所致血小板输注无效(PTR)患者寻求相合或相容的供者血小板输注。方法采用ELISA方法检测PTR患者的血小板抗体及HLA⁃Ⅰ类抗体特异性;运用MATCH IT!和HLA Matchmaker软件,分析患者HLA⁃Ⅰ类抗体特异性及相应抗原决定簇(epitopes);采用HLA⁃SSO分型技术,获得供、患者的HLA基因型;根据HLA⁃I类抗原交叉反应组(CREG)或HLA表位配型(Eplet)策略,寻找与PTR患者相合或相容的供者血小板;通过血小板抗原单克隆抗体特异性免疫固定检测技术(MAIPA)和血小板免疫荧光流式检测(PIFT)鉴定匹配程度;最后,通过血小板计数纠正增加指数(CCI)评估血小板输注效果。结果2名PTR患者体内检测到针对HLA⁃Ⅰ类和CD36的复合抗体,且CD36流式表型为Ⅰ型缺失;抗体特异性检测结果显示,患者1和患者2的血清中存在高频的HLA⁃Ⅰ类抗体,PRA分别为56%(54/96)和53%(51/96);运用HLA的CREG和Eplet配型策略,在CD36缺失供者库分别筛选到与患者1匹配等级C的供者1名,与患者2匹配等级D的供者1名,且选择的供者均规避患者HLA⁃Ⅰ类抗体表位所针对的抗原;MAIPA和PIFT结果亦证实患者与供者血小板无免疫反应,且患者2输注相容血小板24 h CCI>4.5。结论针对HLA和CD36复合抗体所致PTR患者,可联合运用血清学交叉配型、HLA⁃CREG及Eplet配型策略,选择CD36缺失,规避HLA⁃Ⅰ类抗体对应抗原且HLA表位匹配的供者血小板。Objective To search compatible and suitable platelets for platelet transfusion refractoriness(PTR)patient caused by compound antibodies against HLA and CD36.Methods ELISA method was used to detect the antibody against platelet antigens and the specificity of HLA⁃I antibody in PTR patients.The specificity of HLA⁃I antibody and corresponding epitopes of patients were analyzed using MATCH IT!and HLA Matchmaker software.The HLA genotype of both donor and patient was obtained by HLA⁃SSO method.Compatible or suitable donor platelets for PTR patients were searched through cross⁃reactive group(CREG)of HLA⁃I and HLA epitope⁃matched approach(Eplet).The matching degree was identified using monoclonal antibody⁃specific immobilization of platelet an⁃tigens(MAIPA)and the platelet suspension immunofluores⁃cence test(PIFT).Finally,the transfusion effect was evaluated according to the corrected count increment(CCI).Results Compound antibodies against both CD36 and HLA⁃I antigens were detected in two PTR patients,and their phenotype of CD36 was conformed to be type I deficient.Through LSA testing,high⁃frequency of HLA⁃I antibodies was found in these two patients,and the panel reactive antibody in patients 1 and 2 was 56%(54/96)and 53%(51/96),respectively.According to HLA⁃CREG and Eplet matching strategies,one donor of grade C⁃matching with patient 1 and one donor of grade D⁃matc⁃hing with patient 2 were screened from the CD36 deficiency donor bank,respectively.And the selected donors avoided the antigen of HLA⁃I antibody epitope.These results of MAIPA and PIFT also confirmed that no immune response was detected between the patient and the donor.And a CCI of>4.5 within 24 hour of transfusion of compatible platelets was obtained in patient 2.Conclusion For PTR patients caused by HLA and CD36 compound antibodies,a combination strategy including serological cross⁃matching,HLA⁃CREG and Eplet approach should be used to select the CD36 deficient donor platelets which evaded the antigen corresponding

关 键 词：血小板输注无效 HLA⁃Ⅰ类抗体 CD36抗体 HLA表位配型方法 

分 类 号：R457.1[医药卫生—治疗学] R331.143[医药卫生—临床医学]