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临床输血与检验

临床输血与检验 ›› 2021, Vol. 23 ›› Issue (6): 723-727.DOI: 10.3969/j.issn.1671-2587.2021.06.011

• 临床输血 • 上一篇    下一篇

免疫性血小板输注无效患者HLA和/或HPA抗体产生的影响因素分析

敬媛媛, 王洁, 李冬妹, 王丽君, 范成艳, 贾延军   

  1. 100088 北京市红十字血液中心
  • 收稿日期:2021-06-18 出版日期:2021-12-20 发布日期:2021-12-21
  • 通讯作者: 贾延军,男,博士,主任技师,主要从事输血医学和移植免疫学方面的研究,（E-mail）jiayj321@hotmail.com。
  • 作者简介:敬媛媛（1980-）,女,四川人,本科,主管技师,主要从事输血医学和HLA分型方面的工作,（E-mail）29691582@qq.com。

Factors Influencing Development of HLA and/or HPA Antibodies in Patients with Platelet Refractoriness

JING Yuan-yuan, WANG Jie, LI Dong-mei, et al   

  1. Department of HLA, Beijing Red Cross Blood Center, Beijing 100088
  • Received:2021-06-18 Online:2021-12-20 Published:2021-12-21

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摘要： 目的 回顾性分析影响免疫性血小板输注无效（PTR）患者HLA和/或HPA抗体产生的独立危险因素。方法 收集910例PTR患者的临床资料及其HLA和/或HPA抗体检测结果,分析性别、年龄、血型、所患疾病以及输血次数、PTR发生前的血象、凝血指标等对抗体产生的影响。结果 女性及有妊娠史的患者更容易产生HLA和/或HPA抗体。抗体阳性患者的平均年龄明显高于阴性患者（51.46±18.49岁 vs. 40.68±20.08岁,P<0.001）,其平均输血次数却明显低于阴性患者（13.13±18.64次 vs. 18.66±22.52次,P=0.024）,抗体发生率与输血次数无相关性,抗体阳性患者检测前血小板计数值（13.13±18.64×109/L vs. 18.66±22.52×109/L,P=0.021）和血红蛋白含量（72.41±18.64 g/L vs. 78.61±21.66 g/L,P=0.009）也明显低于阴性患者。60岁以上、女性、患有MDS、输血次数、血小板计数值都是抗体产生的独立危险因素。结论 了解HLA和/或HPA抗体产生的危险因素有助于临床医生在治疗过程中采取适当措施避免PTR的发生,改善血小板输注的疗效。

关键词: 血小板输注无效（PTR）, 人类白细胞抗原（HLA）抗体, 血小板抗原（HPA）抗体, 独立危险因素, 回顾性分析

Abstract: Objective The purpose of this study was to retrospectively analyze independent risk factors for HLA and/or HPA antibodies detected in patients with platelet transfusion refractoriness（PTR）. Methods The clinical data of 910 patients with PTR and their status of HLA and/or HPA antibodies were collected. The influence of sex,age,blood group, disease,blood transfusion times,hemogram parameters and coagulation index before PTR occurrence were analyzed. Results HLA and/or HPA antibodies were more easily observed in sera from women and women with a history of pregnancy. The average age of antibody-positive patients was significantly higher than that of antibody-negative patients （51.46±18.49 year vs. 40.68±20.08 year,P<0.001）. The average number of blood transfusion in antibody-positive patients was significantly lower than that in antibody-negative patients （13.13±18.64 vs. 18.66±22.52,P=0.024）. The incidence of antibody was not correlated with the number of blood transfusion. The platelet counts （13.13±18.64×109/L vs. 18.66±22.52×109/L, P=0.021） and hemoglobin levels （72.41±18.64 g/L vs. 78.61±21.66 g/L,P=0.009）in antibody-positive patients were also significantly lower than those in antibody-negative patients. The independent risk factors for antibody production were over 60 years old,female,MDS,frequency of transfusions and platelet counts. Conclusion The understanding of risk factors for the formation of HLA and/or HPA antibody is helpful for clinicians to take appropriate measures to avoid PTR and improve the efficacy of platelet transfusion.

Key words: Platelet transfusion refractoriness（PTR）, Human leucocyte antigen（HLA） antibody, Human platelet antigen （HPA） antibody, Independent risk factor, Retrospective analysis

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