血液病患者异基因造血干细胞移植后Rh血型转变研究  

Transformation of Rh Blood Group in Patients with Blood Diseases Treated with Allogeneic Hematopoietic Stem Cell Transplantation

作　　者：童欣欣 钟明璐 黄慧瑛[1] 邓晖[1] 黄建云[1] 魏亚明[1] TONG Xinxin;ZHONG Minglu;HUANG huiying;DENG Hui;HUANG Jianyun;WEI Yaming(Department of Blood Transfusion,Guangzhou First People's Hospital,Guangzhou 510180)

机构地区：[1]广州市第一人民医院输血医学科、广东省精准输血技术工程中心、广州医科大学输血与血液病研究所,广东广州510180

出　　处：《临床输血与检验》2024年第2期230-236,共7页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：广州市临床重大技术(No.2019ZD18);广东省企联合面上项目(No.2021A1515220044);广州市医药卫生一般引导项目(No.20221A011008)资助。

摘　　要：目的检测血液病患者造血干细胞移植(HSCT)前供、受者及移植后患者的Rh血型抗原C、c、E、e,探究受者Rh血型抗原转变为供者Rh血型抗原C、c、E、e转变时间与过程。方法收集HSCT前供、受者以及移植后患者的抗凝全血标本,用微柱凝胶卡检测ABO血型、Rh血型,统计分析并比较ABO、Rh血型抗原转变与时间。结果排除红细胞输注的影响,58例HSCT患者Rh血型抗原C、c、E、e完全转变为供者的Rh血型抗原所需时间为(57.81±8.99)d,患者的年龄和血液病种类影响Rh血型抗原转换时间,性别、移植方式和供受者ABO血型相合性对Rh抗原转变时间无影响。移植后第3周部分患者开始出现少量供者红细胞,第4周开始检测到混和嵌合状态,第7~10周Rh血型抗原完全转变。此外,比较25例供、受者ABO血型和Rh血型均不相同的HSCT患者的Rh血型抗原转变时间和ABO血型转变时间,Rh血型抗原转变时间较ABO更短,差异具有统计学意义。结论定期检测HSCT患者移植后Rh血型抗原可以作为辅助判断移植效果的指标之一,对HSCT患者移植后输注Rh血型相容性的红细胞具有指导意义。Objective To detect the Rh antigens C,c,E,e in hematopoietic stem cell transplantation(HSCT)patients with blood diseases and donors before and after transplantation,and analyze the time and process of the conversion of Rh blood type from recipients to donor Rh antigens C,c,E,e.Methods Anticoagulant blood samples were collected from patients and donors before and after transplantation for detection of antigen transformation by using microcolumn agglutination card,ABO and Rh antigen conversion time were analyzed and compared.Results Excluding the effects of red blood cell transfusions,the average time length of 58 HSCT patients was 57.81±8.99 days that Rh antigens C,c,E,e completely transformed from recipient to donor after transplantation.Patient age and hematological classification showed impact on the time of Rh antigens conversion,while the gender,ABO blood group compatibility,as well as transplant mode showed no influence on the Rh antigen conversion time.Donor's red blood cells appeared in some patients as early as 3rd week after transplantation,mixed chimerism of donor and patient was detected from the 4th week,and the Rh blood group antigens were found to be completely transformed from the 7th to the 10th week.In addition,both Rh and ABO blood group antigen transition time in 25 HSCT patients those Rh and ABO blood type between patients and donors were different were analyzed,and the Rh transition time was shorter than ABO,and its difference was statistically significant.Conclusion Regular typing of Rh blood group antigen is necessary for patients after HSCT transplantation,and these Rh antigens are indicators to judge transplantation treatment effect,and they also show a significance of guiding transfusion of Rh blood group compatible red blood cells in HSCT patients after transplantation.

关 键 词：异基因造血干细胞移植 RH血型抗原 转变时间 

分 类 号：R457.7[医药卫生—治疗学]