血小板自身抗体在血小板输注无效中的临床意义  

Platelet Transfusion Refractoriness:Understanding the Clinical Significance of Platelet Autoantibodies

作　　者：温玉洁[1] 范成艳 张丹 李冬妹[1] 孙铁成 贾延军[1] 刘娜[1] WEN Yujie;FAN Chengyan;ZHANG Dan;LI Dongmei;SUN Tiecheng;JIA Yanjun;LIU Na(Department of HLA,Beijing Red Cross Blood Center,Beijing 100088)

机构地区：[1]北京市红十字血液中心HLA实验室,北京100088

出　　处：《临床输血与检验》2024年第4期511-515,共5页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：北京市红十字血液中心中心级课题(No.BRCBC2021-02)资助。

摘　　要：目的观察血小板自身抗体与同种抗体对血小板交叉配型难易程度及输注效果的影响。方法选择2021年7月—2023年9月在本实验室完成血小板抗体鉴定的106例血小板输注无效(PTR)患者,根据血小板抗体类型将患者分为两组,20例自身抗体阳性患者为观察组,86例同种抗体阳性患者为对照组。比较两组患者配型相合次数百分率、配型相合供者百分率、输注交叉配型相合血小板及随机血小板的24 h血小板计数增加指数(CCI)值及输注有效率的差异,并对观察组自身抗体变化情况进行追踪。结果观察组的配型相合次数百分率及配型相合供者百分率均高于对照组(P<0.05)。观察组患者输注交叉配型相合血小板与随机血小板的24 h CCI值及输注有效率均无显著性差异(P>0.05),对照组患者输注交叉配型相合血小板的24 h CCI值及输注有效率均高于输注随机血小板(P<0.001),对照组患者输注交叉配型相合血小板后24 h CCI值及输注有效率比观察组高(P<0.05),对照组和观察组输注随机血小板后24 h CCI值及输注有效率无显著性差异(P>0.05)。观察组多数患者的自身抗体强度呈下降趋势。结论血小板自身抗体对血小板交叉配型难易程度及输注效果的影响比同种抗体小。血小板自身抗体强度随时间推移呈现逐渐下降乃至消失的规律。在临床实践中,对于自身抗体患者的治疗,应当首先查找病因,并进行针对性治疗,如果需要输注血小板,可以选择输注随机血小板。Objective To observe the differential impact of platelet autoantibodies and alloantibodies on the complexity of platelet cross-matching procedures and the subsequent efficacy of transfusions.Methods We retrospectively analyzed 106 patients with platelet transfusion refractoriness(PTR)who underwent platelet antibody identification at our laboratory from July 2021 to September 2023.Based on the type of platelet antibody detected,the patients were divided into two groups:the observation group of 20 patients with autoantibodies and the control group of 86 patients with alloantibodies.We compared key outcomes between the two groups,including the percentage of successful matching attempts,the proportion of compatible donors,the 24-hour corrected count increment(CCI)values following cross-matched and random platelet transfusions,and the overall transfusion effectiveness.Additionally,we tracked the changes in autoantibody levels within the observation group.Results The observation group exhibited significantly higher percentages of matching times and matching donors than those in the control group(P<0.05).There was no significant difference in the CCI values or tranfusion effectiveness between cross-matched and random platelets in the observation group(P>0.05),while in the control group transfusions of cross-matched platelets yielded significantly higher 24-hour CCI values and effectiveness rates than those with random platelets(P<0.001).Although the 24-hour CCI values of crossed-matched platelet recipients and effectiveness rates in the control group exceeded those in the observation group(P<0.05),no significant difference was detected between random platelet recipients across both groups(P>0.05).Over time,autoantibody levels in the observation group generally decreased.Conclusion Platelet autoantibodies exert a lesser influence on the challenges associated with platelet crossedmatching and transfusion outcomes compared to alloantibodies.The intensity of platelet autoantibodies shows a pattern of gradually decreasing an

关 键 词：血小板自身抗体 血小板输注无效(PTR) 血小板交叉配型 固相凝集法(SPA) 

分 类 号：R457[医药卫生—治疗学]