供体血浆回冲LRS室防止CD4+和CD8+T淋巴细胞减少的研究  

Donor plasma reinfusion flushing of the LRS chamber to prevent CD4+and CD8+T lymphopenia

作　　者：李繁海 陈晓文[1] 周林枫 黄杰庭[1] 李晓帆[1] 钟笔 肖媚 梁华钦[1] LI Fanhai;CHEN Xiaowen;ZHOU Linfeng;HUANG Jieting;LI Xiaofan;ZHONG Bi;XIAO Mei;LIANG Huaqin(Guangzhou Blood Center,Guangzhou 510091,China)

机构地区：[1]广州血液中心、广州市血液安全重点实验室,广东广州510091

出　　处：《中国输血杂志》2024年第9期1058-1062,1072,共6页Chinese Journal of Blood Transfusion

基　　金：广州市科学技术局科技计划项目(2023A03J0556);广州市医学重点学科(2021-2023年)项目。

摘　　要：目的探讨Trima Accel自动化采血系统最后回输时使用供体血浆回冲白细胞减少系统(LRS)室对预防CD4+、CD8+T淋巴细胞减少效果。方法本实验设计了纵向随访和横断面研究。我们选择CD4+计数<200个细胞/μL、CD8+计数<125个细胞/μL作为缺乏的判断标准。对18名初次单采血小板献血者进行随访,并于最近300 d内献血者第0次、3~6次、7~14次献血前检测淋巴细胞计数。以170名未献过血的健康献血者为对照组。按回输模式调整为使用供体血浆回冲的时间(2021年10月)为分界点,将88名最近365 d内(中位献血次数17.5次以上)主要使用自动化采血系统采集捐献单采血小板的既往频繁献血者分为3组并获血液样本:A、B、C各组开始捐献单采血小板的时间分别为2019年10月前、2019年10月至2021年9月、2021年10月后。对血液样本进行分析,以获取包含CD4+、CD8+T淋巴细胞在内的血细胞计数。通过对比分析,随访组不同献血次数时检测指标和对照组与A、B、C各组检测指标有无统计学差异,从而推断供体血浆回冲白细胞减少系统(LRS)室对预防CD4+、CD8+T淋巴细胞减少效果。结果调整回输模式后,18名初次献血者转化的频繁单采献血者,在第5、11次(中位献血次数)献血时没有出现CD4+和CD8+T淋巴细胞减少的情况,且上述指标与其0次献血时无统计学差异。既往频繁献血者中,B、C组CD4+、CD8+T淋巴细胞计数均高于判断标准值,与对照组没有统计学差异。A组CD4+T淋巴细胞正常,仅A组1人CD8+T淋巴细胞低于125个细胞/μL,其累计捐献单采血小板281次,其所在的组在回输模式调整前2~21年(中位数为5年)已经开始献血。A组CD4+、CD8+T淋巴细胞计数与对照组差异明显,其CD4+、CD8+T淋巴细胞计数中位数(A组/对照组)分别为359/521、257/372,P<0.001。A组0%(0/35)CD4+计数<200个细胞/μL,2.85%(1/35)的献血者CD8+<125个细胞/μL,远低于John M.Gansner和Mahboubeh RahObjective To explore the effectiveness of using donor plasma reinfusion to flush the leukoreduction system(LRS)chamber during the final reinfusion phase with the Trima Accel automated blood collection system in preventing the reduction of CD4+and CD8+T lymphocytes.Methods A longitudinal and cross-sectional study was designed.CD4+count<200 cells/μL and CD8+count<125 cells/μL were considered as the criteria for deficiency.Eighteen first-time platelet donors were followed up.The lymphocyte count was measured at 0,3-6 and 7-14 times of blood donation in the last 300 days.170 healthy blood donors who have not donated blood were selected as the control group.According to the cut-off point(October 2021),88 blood donors who mainly used automatic blood collection system to donate platelet apheresis in the last 365 days(median blood donation times≥17.5)were divided into three groups(A,B and C)and blood samples were obtained.The time for Groups A,B and C started donating platelet apheresis were as follows:Group A:before October 2019,Group B:from October 2019 to September 2021,Group C:after October 2021.Blood samples were analyzed to obtain blood counts including CD4+and CD8+T lymphocytes.Blood samples were analyzed to obtain blood cell counts including CD4+and CD8+T lymphocytes.Through a comparative analysis,this study aimed to determine if there are any statistical differences in the detection indices between the follow-up groups with varying frequencies of blood donation,the control group,and groups A,B,and C.This approach was employed to infer the efficacy of donor plasma reinfusion in flushing the leukoreduction system(LRS)chamber for preventing the decline of CD4+and CD8+T lymphocytes.Results Eighteen first-time blood donors who were converted to regular platelet apheresis donors did not show a decrease of CD4+and CD8+T lymphocytes in the 5 th and 11 th blood donation(median number of blood donation),and there was no significant difference between the above indexes and those in the 0 th blood donation.Among the pre

关 键 词：供体血浆回冲 白细胞减少系统(LRS)室 预防CD4+T/CD8+T淋巴细胞 

分 类 号：R457.14[医药卫生—治疗学] R331.144[医药卫生—临床医学]