血小板输注效果与KIR-HLA受配体相合度的相关性研究  

Study on relationship between platelet transfusion efficacy and KIR-HLA receptor-ligand compatibility

作　　者：韩瑜[1] 杨帆[1] 焦立新[1] 刘玲玲 于江虹[1] 聂婷婷 刘鑫 白日新 杨旭 陈颖 李妍霏 李凯烨 于小棠 HAN Yu;YANG Fan;JIAO Lixin;LIU Lingling;YU Jianghong;NIE Tingting;LIU Xin;BAI Rixin;YANG Xu;CHEN Ying;LI Yanfei;LI Kaiye;YU Xiaotang(Changchun Central Blood Station,Changchun 130033,China)

机构地区：[1]长春市中心血站,吉林长春130033

出　　处：《中国输血杂志》2023年第7期567-570,共4页Chinese Journal of Blood Transfusion

基　　金：吉林省卫生健康科技能力提升项目(2022JC088)。

摘　　要：目的研究血小板输注效果与KIR受配体的关联性。方法33例HLA抗体检测阳性白血病患者与供者血小板进行交叉配型试验,选取合适供者的血小板输注,以24 h血小板校正计数指数(CCI)判定输注效果。采用PCR-SSP方法分别对患者和供者的血液标本进行KIR及配体基因分型,分析血小板输注效果和受者KIR、供者HLA配体的相关性。结果在74次血小板输注中,输注无效42人次,输注有效32人次。供者存在C2基因、HLA-B Bw480T基因,受者输注血小板无效的频率分别为69.0%(29/42),52.4%(22/42),显著高于有效组25.0%(8/32),25.0%(8/32)。供者存在C1基因,受者输注血小板有效的频率分别为100.0%(32/32),高于无效组83.3%(35/42)。当受者-供者匹配模式为KIR2DL1-C2和KIR3DL1-(HLA-B Bw4-80T)受者输注血小板发生无效的频率为69.0%(29/42)和40.5%(22/42),高于有效组的频率25%(8/32)和18.8%(6/32)。当受者-供者匹配模式为KIR2DL3-C1,受者输注血小板发生有效为32例(100.0%)高于无效组35例(83.3%)。受者iKIR与供者HLA配体发生错配,错配模式为KIR2DL1-C2错配,受者输注血小板有效的频率为78.1%(25/32),远高于无效组的31.0%(13/42)。当错配模式为KIR3DL1-(HLA-B Bw4-80T)错配,受者血小板输注有效的频率为68.8%(22/32)高于无效组的42.9%(18/42)。以上各组比较差异均具有统计学意义,P<0.05。结论在血小板输注中HLA-C1和HLA-C2基因是影响血小板输注效果的关键性因素,HLA-C1是血小板输注无效的保护性基因,而HLA-C2和HLA-B Bw4-80T是血小板输注无效的易感性基因,受者iKIR+供者HLA的受配体模式可能在血小板输注无效中的扮演重要作用。Objective To study the correlation between platelet transfusion efficacy and KIR receptor-HLA ligand.Methods Thirty-three leukemia patients with positive HLA antibody were tested for cross-matching with donor platelets.Platelets from suitable donors were selected for transfusion,and the 24-hour platelet corrected count increment(CCI)was used to determine the transfusion effect.KIR and ligand genotyping were performed on blood samples from patients and donors by PCR-SSP method,and the relationship between platelet transfusion effects and KIR receptor-HLA ligand was analyzed.Results In 74 occasions of platelet transfusion,42 were ineffective and 32 were effective.When the donor had C2 gene and HLA-B Bw4-80T gene,the frequency of ineffective platelet transfusion in the recipient was 69.0%(29/42)and 52.4%(22/35),respectively,which was significantly higher than that in the effective group[25.0%(8/32)and 25.0%(8/32)].When the donor had C1 gene,and the frequency of effective platelet transfusion in the recipient was 100.0%(32/32),which was higher than that in the ineffective group[83.3%(35/42)].When the recipient-donor matching mode was KIR2DL1-C2 and KIR3DL1-(HLA-B Bw4-80T),the frequency of ineffective platelet transfusion was 69.0%(29/42)and 40.5%(22/42),higher than that of the effective group[25%(8/32)and 18.8%(6/32)].When the recipient-donor matching model was KIR2DL3-C1,the rate of effective platelet transfusion in 32 patients(100.0%),which was higher than that(35 patients 83.3%)in the ineffective group.When the mismatch mode of recipient iKIR+donor HLA ligand receptor was KIR2DL1-C2,the frequency of effective platelet transfusion in the recipient was 78.1%(25/32),which was much higher than that in the ineffective group[31.0%(13/42)].When the mismatch mode was KIR3DL1-(HLA-B Bw4-80T),the rate of effective platelet transfusion in the recipient was 68.8%(22/32),which was higher than that in the ineffective group(42.9%,18/42).The difference between the above groups was statistically significant(P0.05).Conclusion HLA-C

关 键 词：血小板 配体 HLA-C KIR 血小板输注无效 

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