单采血小板不同储存期细胞外囊泡含量变化、储存损伤与临床疗效的研究  

Study on the changes of extracellular vesicle content of platelets at different storage periods,storage lesion and clinical efficacy

作　　者：丁芳 韩秀华 李晓明 陆萍 DING Fang;HAN Xiuhua;LI Xiaoming;LU Ping(Shanghai Jiading District Blood Station,Shanghai 201821,China;Department of Blood Transfusion,Shanghai Jiading District Central Hospital,Shanghai 201800,China)

机构地区：[1]上海市嘉定区血站,上海201821 [2]上海市嘉定区中心医院输血科,上海201800

出　　处：《中国输血杂志》2024年第11期1256-1263,共8页Chinese Journal of Blood Transfusion

基　　金：嘉定区自然科学研究课题[JDKW-2021-0049(2021-2024)]。

摘　　要：目的分析单采血小板不同储存期细胞外囊泡的含量变化,跟踪患者的细胞外囊泡和输注疗效,探讨血小板细胞外囊泡在单采血小板储存损伤和输注疗效间存在的机制。方法对本站2022年11月—2024年4月采集的85份单采血小板使用流式细胞仪检测采集当天和输注前的血小板细胞外囊泡含量,观察储存d1-5血小板细胞外囊泡的含量变化,并选择急性白血病患者为输注对象,跟踪其输注前血小板计数和血小板细胞外囊泡的含量,输注后24 h内检测血小板计数、血小板细胞外囊泡的含量和临床疗效,分析探讨血小板细胞外囊泡与储存损伤和临床输注疗效的机制。结果单采血小板输注前的细胞外囊泡含量(8.73±4.84)明显高于采集当天血小板细胞外囊泡含量(5.11±3.33),差异有统计学意义(P<0.01)。单采血小板储存d2~5血小板细胞外囊泡含量增加值依次为(2.55±1.38,3.49±2.63,3.86±3.55,4.50±3.91),差异有统计学意义(P<0.05)。患者输血后血小板细胞外囊泡含量与输血前细胞外囊泡含量及输注时单采血小板血袋内细胞外囊泡含量呈正相关,差异有统计学意义(P<0.001)。输注单采血小板85例,有效输注61例CCI值为(13.43±4.70),无效输注24例CCI值为(2.27±3.67),差异有统计学意义(P<0.001)。输注不同储存期的单采血小板后,患者输注有效率d2-5依次为(88.89%、68.42%、68.18%、57.14%),对应的CCI值为(11.18±6.10,10.43±6.77,9.53±6.75,9.48±8.86),CCI组间差异无统计学意义(P>0.05)。患者输血前和输血后血小板细胞外囊泡含量与输注疗效CCI无显著性相关(P>0.05)。单采血小板输注前血小板细胞外囊泡含量与输注疗效CCI无显著性相关(P>0.05)。结论单采血小板细胞外囊泡含量随储存时间延长而增加,可作为潜在储存期内的血液质量评价监测指标,但与输注疗效CCI无显著性差异。Objective To analyze the changes of platelet extracellular vesicles(PEVs)content in apheresis at different storage periods,track the PEVs and transfusion efficacy of patients,and explore the mechanism of PEVs in relation to platelet storage damage and transfusion efficacy.Methods From November 2022 to April 2024,a total of 85 apheresis platelets samples were collected at Jiading District Blood Station.Flow cytometry was used to detect the content of PEVs on the day of collection and before transfusion.The changes in the content of PEVs stored for 1 to 5 days were observed.Patients with acute leukemia were selected as transfusion recipients,and their content of platelet count and PEVs before transfusion and within 24 hours after transfusion,and the efficacy were tracked to explore the mechanism of PEVs in relation to storage lesion and transfusion efficacy.Results The content of PEVs before platelet infusion(8.73±4.84)was significantly higher than that on the day of platelet collection(5.11±3.33),and the difference was statistically significant(P<0.01).The increase in the content of PEVs in storage for 2 to 5 days was 2.55±1.38,3.49±2.63,3.86±3.55 and 4.50±3.91,with statistically significant difference(P<0.05).The PEVs content in patients after blood transfusion was positively correlated with that before transfusion and that in apheresis platelet bags during transfusion(P<0.001)A total of 85 cases of apheresis platelet transfusion were conducted,with 61 effective transfusions having a CCI value of(13.43±4.70),and 24 transfusion refractoriness cases having a CCI value of(2.27±3.67),showing a statistically significant difference(P<0.001).The transfusion effectiveness rates for patients receiving different storage periods of apheresis platelets of 2 to 5 days were 88.89%,68.42%,68.18%and 57.14%respectively,with corresponding CCI values of 11.18±6.10,10.43±6.77,9.53±6.75 and 9.48±8.86,and there was no significant difference between CCI groups(P>0.05).There was no significant correlation between the PEVs co

关 键 词：单采血小板 储存损伤 细胞外囊泡 微囊泡 外泌体 

分 类 号：R331.143[医药卫生—人体生理学] R457.12[医药卫生—基础医学]