HLA抗原抗体表达对交叉配型与输注效果的影响  

Impact of HLA antigen and antibody expression on cross-matching and transfusion effect

作　　者：何红红 成婧[2] 王仪含 蒋敏[2] 汤龙海[1] HE Honghong;CHENG Jing;WANG Yihan;JIANG Min;TANG Longhai(Suzhou Blood Center,Suzhou 215006,China;Department of Blood Transfusion,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州市中心血站,江苏苏州215006 [2]苏州大学附属第一医院输血科,江苏苏州215000

出　　处：《中国输血杂志》2025年第3期316-321,共6页Chinese Journal of Blood Transfusion

基　　金：苏州市卫生青年骨干人才“全国导师制”培训项目(Qngg2022033);苏州市姑苏卫生人才计划(GSWS2022096;2022-160);苏州市卫生科技项目(SKY2023077);苏州市公卫专项项目(GWZX202303)。

摘　　要：目的 研究血小板输注无效(platelet transfusion refractoriness, PTR)患者体内HLA-Ⅰ类血小板抗体表达强度与血小板交叉配型间的关系,进一步评估其他影响因素,为提高血小板输注效率、优化血小板输注方案提供相关数据支持。方法 Luminex单抗原流式微珠法检测35例血液病患者血小板特异性抗体;而后采用Capture-P法将存在HLA-Ⅰ类抗体的血浆与已知HLA-Ⅰ类基因分型的血小板进行102次交叉配型,评估交叉配型结果并追踪临床输注效果。结果 HLA-Ⅰ类抗体和HPA抗体在本研究中的阳性检出率为48.6%(17/35);而102次血小板交叉配型阴性率为37.3%(38/102),多种因素影响血小板交叉配型,如HLA-Ⅰ类抗体表达水平和抗体种类、抗原表达水平、交叉反应组和功能性表位(eplets)等,其中HLA-Ⅰ类抗体的表达水平和抗体种类是主要的影响因素,但临床血小板输注有效性并非完全受控于血小板交叉配型相合程度。结论 临床配型在规避强阳性HLA-Ⅰ类抗体的同时也要警惕弱阳性HLA-Ⅰ类抗体导致的配型不合;或需建立HLA-Ⅰ类低表达抗原数据库作为1种较好的替代性血小板供者选择策略,并逐步探索“低表达错配”策略对临床血小板输注的有效性。Objective To study the relationship between the expression intensity of HLA-Ⅰplatelet antibodies in pa-tients with platelet transfusion refractoriness(PTR)and platelet cross-matching,and to further evaluate other factors in or-der to provide relevant data support for improving platelet transfusion efficiency and optimizing platelet transfusion regimens.Methods Luminex single antigen flow cytometry was used to detect platelet specific antibodies in 35 patients with hemato-logical disease.Subsequently,the Capture-P method was employed to perform 102 crossmatchings between plasma with HLA-Ⅰantibodies and platelets with known HLA-Ⅰgenotypes.The cross-matching results were assessed and the clinical transfusion outcomes were tracked.Results The positive detection rate of HLA-Ⅰand HPA antibodies in this study was 48.6%(17/35).The negative rate of cross-matching in 102 cases was 37.3%(38/102).Multiple factors affect platelet cross-matching,such as HLA-Ⅰantibody expression level and antibody type,antigen expression level,cross-reactivity group and eplets.Among them,the expression level and antibody type of HLA-Ⅰantibody are the main influencing factors.However,the effectiveness of clinical platelet transfusion is not completely determined by the compatibility of platelet cross-matching.Conclusion In addition to avoiding strong positive HLA-Ⅰantibodies,clinical matching should also be vigilant against the serological cross-incompatibility caused by weak positive HLA-Ⅰantibodies.It may be necessary to establish HLA-Ⅰlow expression antigen database as a better alternative platelet donor selection strategy,and gradually explore the effectiveness of‘low expression mismatch’strategy for clinical platelet transfusion.

关 键 词：HLA-Ⅰ类抗体 血小板交叉配型 Eplet HLA-Ⅰ类低表达抗原 

分 类 号：R446[医药卫生—诊断学]