免疫性血小板输注无效患者血清中血小板相关抗体的变化及其临床意义  

Changes in Serum Platelet-related Antibodies in Patients with Immune Platelet Transfusion Refractoriness and Clinical Significance

作　　者：范成艳 温玉洁[1] 廉雪 张丹 王洁[1] 敬媛媛[1] 王丽君[1] 李伟[1] 贾延军[1] 李冬妹[1] FAN Chengyan;WEN Yujie;LIAN Xue;ZHANG Dan;WANG Jie;JING Yuanyuan;WANG Lijun;LI Wei;JIA Yanjun;LI Dongmei(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5期661-666,共6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.BRCBC2021-03)资助。

摘　　要：目的分析免疫性血小板输注无效(IPTR)患者血清中血小板相关抗体的变化情况及其对血小板输注效果的影响。方法30例确认为IPTR的患者,收集其性别、年龄、血型、身高、体重、疾病类型、输注前后血小板计数等资料,分别于0、1、3、6个月时检测其血清中的HLA抗体和HPA抗体。ELISA方法进行血小板相关抗体检测,通过计算获得抗体相对强度。微珠法进行HLA特异性抗体检测。结果在随访的30例患者中,共有12例患者的抗体转阴,平均转阴时间为(4.08±1.78)M,7例患者呈现强度逐渐减弱的趋势,另有10例患者呈现稳定存在状态。HLA抗体相对强度的变化同时伴有HLA特异性抗体种类的变化,二者呈正相关趋势。患者HLA抗体相对强度的降低使患者更容易找到交叉配型相合的供者,但是对输注交叉配型相合血小板后的24 h血小板计数纠正增加指数(CCI)和输注有效率没有显著的影响。结论大多数IPTR患者血清中的HLA抗体在6个月内减弱或消失,部分患者的HLA抗体持续稳定存在。抗体减弱或消失同时伴随特异性抗体种类的减少,使患者更容易找到交叉配型相合的供者,但对其输注效果无显著影响。Objective To investigate the changes of platelet-related antibodies in the serum from patients with immune platelet transfusion refractoriness(IPTR)and their effectiveness of a platelet transfusion.Methods Data of 30 patients with IPTR were collected,such as gender,age,blood group,height,weight,diseases,platelet count before and after platelet transfusion etc.,and the serum HLA and HPA antibodies were detected at 0,1,3,and 6 months,respectively.Platelet antibodies were detected by ELISA and the relative intensity of antibodies was calculated.The specific HLA antibodies were detected by microbead technology.Results During follow-up,antibodies became negative in 12 of 30 patients,and the average clearance time was(4.08±1.78)month.Seven patients showed a decreasing trend,and 10 patients showed a stable state.There was a positive correlation between the relative strength of HLA antibody and HLA specific antibody types.The decrease in the relative strength of HLA antibodies made it easier for patients to find an HLA-matched donor,but had no significant effect on the 24 h corrected count increment(CCI)and transfusion response rate after cross-matched platelet transfusions.Conclusion The HLA antibodies in the serum in most PTR patients were weakened or disappeared within 6 months,and persisted steadily in some patients.The reduction or disappearance of antibodies accompanied with the reduction of specific antibody types,made it easier for patients to find cross-matched donors,but had no significant effect on their transfusion efficacy.

关 键 词：免疫性血小板输注无效(IPTR) 血小板相关抗体变化 HLA特异性抗体 血小板交叉配型 

分 类 号：R457[医药卫生—治疗学]