ABO次侧不相合血小板输注的有效性和安全性初步研究  

The Preliminary Analysis of the Effectiveness and Safety of Minor ABO Incompatible Platelet Transfusions

作　　者：阳雪新 袁咏梅 吴兆勇 苑召虎 刘珍 童欣欣 陈小卫[1] 魏亚明[1] YANG Xuexin;YUAN Yongmei;WU Zhaoyong;YUAN Zhaohu;LIU Zhen;TONG Xinxin;CHEN Xiaowei;WEI Yaming(Department of Blood Transfusion,Guangzhou first people's Hospital,Guangzhou,Guangdong 510180;Department of Blood Transfusion,Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,Shenzhen,Guangdong 518104;Department of Blood Transfusion,The Second Affiliated Hospital of Guangdong Medical University,Zhanjiang,Guangdong 524003)

机构地区：[1]广州市第一人民医院输血医学科,广东广州510180 [2]深圳市中西医结合医院输血科,广东深圳518104 [3]广东医科大学附属第二医院输血科,广东湛江524003

出　　处：《临床输血与检验》2024年第1期42-49,共8页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：广东省企联合面上项目(No.2021A1515220044);广州市临床重大技术项目(No.2019ZD18)资助。

摘　　要：目的研究分析紧急特殊情况下ABO次侧不相合血小板输注的有效性与安全性,为ABO次侧不相合血小板输注提供科学依据。方法①收集2013年1月—2023年6月广州市第一人民医院,深圳市中西医结合医院及广东医科大学附属第二医院紧急特殊情况下的24人次ABO次侧不相合血小板输注,为ABO次侧不相合组;收集同期ABO同型血小板输注610人次,用倾向评分匹配的方法从中筛选出拥有相似特征的24人次ABO同型血小板输注,为ABO同型组。比较两组间血小板输注疗效,患者住院天数及肝肾功能等指标的差异,分析ABO次侧不相合组急性溶血性输血反应发生率。②体外模拟受血者输注ABO次侧不相合血小板,盐水介质法检测输注后的红细胞凝集强度。结果①回顾分析中ABO次侧不相合组的血小板差值(ΔPLT)和血小板回收率(PPR)分别为(18.0±20.2)×10^(9)/L,(55.4±54.5)%;ABO同型组则分别为(20.6±15.4)×10^(9)/L,(61.9±48.9)%,以上指标两组间无统计学差异,t值分别为0.51,0.46,P均>0.05。②ABO次侧不相合组患者的住院天数,谷丙转氨酶(ALT),肌酐(Cr),IgG免疫球蛋白,IgM免疫球蛋白,CD4计数,CD8计数及B淋巴细胞计数分别为(30.4±17.8)d,(33.0±16.3)U/L,(104.9±64.7)μmol/L,(9.1±2.6)g/L,(1.24±0.83)g/L,(299.3±341.5)cells/μL,(475.7±283.9)cells/μL,(142.8±218.6)cells/μL;ABO同型组患者则分别为(29.5±17.5)d,(31.1±40.5)U/L,(95.6±55.6)μmol/L,(11.8±3.0)g/L,(0.96±0.42)g/L,(397.3±250.9)cells/μL,(622.7±406.6)cells/μL,(190.7±216.6)cells/μL,以上指标两组间无统计学差异,t值分别为0.15,0.01,0.39,1.90,1.03,0.72,0.65,0.21,P均>0.05。③回顾性研究中有24人次的ABO次侧不相合血小板输注,未观察到急性溶血性输血反应发生。④模拟1治疗量的A型血小板输给B型(或AB型)成人后的红细胞凝集反应结果为阴性;模拟1治疗量的B型血小板输给A型(或AB型)成人后的红细胞凝集反应结果为阴性;模拟1治疗量的O型血Objective Analyze the effectiveness and safety of minor ABO incompatible platelet transfusions and ABO compatible platelet transfusions in emergency special cases,and promote a scientific basis for the clinical application of minor ABO incompatible platelet transfusions.Methods①24 cases of minor ABO incompatible platelet transfusions were collected as minor ABO incompatible group in emergency special cases from Guangzhou First People's Hospital,Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine,The Second Affiliated Hospital of Guangdong Medical University from January 2013 to June 2023;610 cases of ABO compatible platelet transfusions were collected during the same period,and 24 cases of them with similar characteristics were selected as ABO compatible group using propensity score matching method.The differences were compared in the effectiveness of platelet transfusions,hospitalization days,Liver and kidney function etc between two groups.Analyzed the acute hemolytic transfusion reaction rate of minor ABO incompatible platelet transfusions.②The minor ABO incompatible platelet transfusions were simulated in blood recipients,the strength of red blood cell agglutination were detected by Saline Medium.Results①There were no differences in the effectiveness of platelet transfusions between the minor ABO incompatible group and the ABO compatible group,ΔPLT were(18.0±20.2)×10^(9)/L,(20.6±15.4)×10^(9)/L respectively,t value was 0.51,P=0.61;PPR were(55.4±54.5)%,(61.9±48.9)%respectively,t value was 0.46,P=0.65.②The hospitalization days,ALT,Cr,IgG,IgM,CD4,CD8 and B lymphocytes of the minor ABO incompatible group were(30.4±17.8)d,(33.0±16.3)U/L,(104.9±64.7)μmol/L,(9.1±2.6)g/L,(1.24±0.83)g/L,(299.3±341.5)cells/μL,(475.7±283.9)cells/μL,(142.8±218.6)cells/μL;the ABO compatible group were(29.5±17.5)d,(31.1±40.5)U/L,(95.6±55.6)μmol/L,(11.8±3.0)g/L,(0.96±0.42)g/L,(397.3±250.9)cells/μL,(622.7±406.6)cells/μL,(190.7±216.6)cells/μL respectively,there were no differences bet

关 键 词：血小板 ABO血型 ABO次侧不相合 输血 溶血 疗效 

分 类 号：R457[医药卫生—治疗学]