先天性心脏病患儿血小板抗体导致凝血功能异常与血小板功能减弱的研究  

Platelet antibody production in children with congenital heart disease leading to coagulation dysfunction and reduced platelet function

作　　者：甄自达 付晓艳 张慧敏[1] 刘禹 马曙轩[1] ZHEN Zida;FU Xiaoyan;ZHANG Huimin;LIU Yu;MA Shuxuan(Capital Medical University Affiliated Beijing Children′s Hospital,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院,北京100045

出　　处：《中国输血杂志》2024年第12期1388-1393,共6页Chinese Journal of Blood Transfusion

摘　　要：目的分析先天性心脏病患儿血小板抗体的产生情况,检测抗体类型,并探讨其对血小板数量、凝血功能及血小板功能的影响。方法回顾性分析2019年1月至2024年6月于北京儿童医院就诊的3504例无输血史先天性心脏病患儿,研究血小板抗体阳性率,通过固相凝集法检测抗体类型,分析患儿血小板计数与凝血功能,使用凝血与血小板功能分析仪评估血小板抗体对血小板功能的影响。结果无输血史的先天性心脏病患儿血小板抗体阳性率为9.7%(341/3504),高于整体患儿群体的6.6%(2657/40311)。血小板抗体阳性先天性心脏病患儿的血小板抗体主要为自身抗体。血小板抗体阳性患儿与阴性患儿血小板计数差异不显著,但阳性患儿凝血酶原时间(12.19±1.07)s显著长于阴性患儿(11.32±0.77)s。与未致敏血小板相比,血小板抗体致敏的血小板功能明显降低。结论先天性心脏病患儿自身血小板抗体阳性率较高,血小板抗体与凝血功能异常有关,并可导致血小板功能降低。Objective To analyze the production of platelet antibodies in children with congenital heart disease,identi-fy the types of antibodies,and explore their effects on platelet count,coagulation function and platelet function.Methods A retrospective analysis was conducted on 3504 congenital heart disease patients without a history of blood transfusion who were treated at Beijing Children′s Hospital between January 2019 and June 2024 to study the positive rate of platelet antibod-ies.Platelet antibody types were detected using the solid-phase agglutination method,and the platelet count and coagulation function of the children were analyzed.The impact of platelet antibodies on platelet function was evaluated using a coagula-tion and platelet function analyzer.Results The positive rate of platelet antibody in children with congenital heart disease with no history of blood transfusion was 9.7%(341/3504),higher than the overall positive rate of 6.6%(2657/40311)in the general pediatric population.The platelet antibodies in congenital heart disease cases with positive platelet antibodies were mainly autoantibodies.There was no significant difference in platelet count between antibody-positive children and an-tibody-negative children.However,the prothrombin time(s)of antibody-positive children was significantly longer than that of antibody-negative children[(12.19±1.07)vs(11.32±0.77)].Platelets sensitized by antibodies showed a significant reduction in function compared to non-sensitized platelets.Conclusion Children with congenital heart disease have a high rate of positivity for autoantibodies,which are associated with abnormalities in coagulation function and can lead to reduced platelet function.

关 键 词：先天性心脏病 血小板抗体 凝血功能 血小板功能 

分 类 号：R558[医药卫生—血液循环系统疾病] R457.1[医药卫生—内科学]