直接抗人球蛋白阳性强度对危重症患者输血的影响  

Impact of direct anti-human globulin positive intensity on blood transfusion in critically ill patients

作　　者：谷玉清 刘雅丽 盛瑾年 许绍国 何芮 茂红 刘淼[3] 张玉侠[4] Gu Yuqing;Liu Yali;Sheng Jinnian;Xu Shaoguo;He Rui;Bian Maohong;Liu Miao;Zhang Yuxia(Department of Blood Transfusion,the Third People's Hospital of Hefei,the Third Clinical College of Hefei,Anhui Medical University,Hefei 23001l,China)

机构地区：[1]合肥市第三人民医院输血科安徽医科大学合肥第三临床学院,安徽合肥230011 [2]安徽医科大学第一附属医院输血科 [3]安徽医科大学病原生物学教研室 [4]安徽医科大学病理生理学教研室

出　　处：《中国急救医学》2025年第3期237-244,共8页Chinese Journal of Critical Care Medicine

基　　金：合肥市第三人民医院院级扶持科学基金(SYKT202303);安徽省实验室开放基金项目(IMMDL202105)。

摘　　要：目的比较不同直接抗人球蛋白(DAT)阳性强度对危重症患者输血的影响。方法回顾性收集2015年1月至2024年3月合肥市第三人民医院、安徽医科大学附属第一医院收治80例DAT阳性危重症患者的临床资料,根据输血制品不同分为对照组(n=40)和实验组(n=40),对照组输注洗涤红细胞,实验组输注悬浮红细胞。比较两组不同DAT阳性强度患者的配血结果,不同DAT阳性强度输注红细胞临床疗效、不同DAT阳性强度溶血指标差异以及DAT阳性强度与溶血的相关性。结果不分组、对照组、实验组不同DAT阳性强度患者主配血结果比较,差异有统计学意义(P<0.05);实验组不同DAT阳性强度患者次侧配血结果比较,差异有统计学意义(P<0.05)。经Kendall′s tau-b相关性检验显示,DAT阳性强度与主、次侧配血结果均呈正相关关系(r>0,P<0.05)。80例患者中不规则抗体筛查阳性19例,实验组9例,对照组10例;不分组、实验组、对照组不规则抗体阳性患者中DAT阳性强度分布比较,差异均有统计学意义(P<0.05)。经Kendall′s tau-b相关性检验显示,DAT阳性强度与不规则抗体筛查呈正相关关系(r>0,P<0.05)。DAT阳性强度2+及以下两组患者输注疗效比较,差异无统计学意义(P>0.05);DAT阳性强度3+及以上对照组输注疗效明显优于实验组(P<0.05)。实验组不同DAT阳性强度输注疗效比较,差异有统计学意义(P<0.05)。实验组不同DAT阳性强度患者红细胞输注量比较,差异有统计学意义(P<0.05)。经Pearson相关性检验显示,DAT阳性强度3+及以上强度与红细胞输注量呈负相关关系(r<0,P<0.05)。输血前,实验组不同DAT阳性强度血红蛋白(Hb)、红细胞(RBC)、网织红细胞(Ret)比较,差异无统计学意义(P<0.05),但总胆红素(TBIL)在DAT阳性强度≤1+、2+、3+、4+患者中呈递增变化(均P<0.05);输血后,不同DAT阳性强度Hb、RBC较同一强度输血前均升高,Ret均降低,差异有统计学意义(均P<0.05)Objective To compare the impact of different positive antibody intensities of direct anti-human globulin(DAT)on blood transfusion in critically ill patients.Methods Clinical data of 80 critically ill patients with positive DAT admitted to the Third People′s Hospital of Hefei and the First Affiliated Hospital of Anhui Medical University from January 2015 to March 2024 were retrospectively collected.They were divided into an experimental group(n=40)and a control group(n=40)based on different blood transfusion products.The control group received washed red blood cells infusion,while the experimental group received suspended red blood cells infusion.The blood matching results of two groups in the patients with different DAT positive intensities,the clinical efficacy of red blood cell infusion with different DAT positive intensities,the differences in hemolytic indicators with different DAT positive intensities,and the correlation between DAT positive intensities and hemolysis were compared.Results There were statistically significant differences in the results of primary blood matching among the experimental group,the control group and the patients with different DAT positive intensity in the case of non-grouping(P<0.05).There was a statistically significant difference in the results of secondary blood matching in the patients with different DAT positive intensity in the experimental group(P<0.05).According to Kendall′s tau-b correlation test,the intensity of DAT positivity was positively correlated with both primary and secondary blood matching results(r>0,P<0.05).Out of 80 patients,19 patients were positive for irregular screening,with 9 in the experimental group and 10 in the control group.There were statistically significant differences in the distribution of DAT positivity intensity among irregular antibody positive patients of the experimental group,the control group and non-grouping(P<0.05).Kendall′s tau-b correlation test showed a positive correlation between DAT positive intensity and irregular antibod

关 键 词：危重症 直接抗人球蛋白试验 阳性强度 输血 洗涤红细胞 悬浮红细胞 

分 类 号：R457.1[医药卫生—治疗学] R459.7[医药卫生—临床医学]