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临床输血与检验

临床输血与检验 ›› 2024, Vol. 26 ›› Issue (3): 353-358.DOI: 10.3969/j.issn.1671-2587.2024.03.009

• 临床输血 • 上一篇    下一篇

免疫性血小板输注无效患者HLA/HPA抗体特性分析及其对血小板输注效果的影响*

范成艳, 温玉洁, 张丹, 廉雪, 刘娜, 孙铁成, 王东梅, 贾延军, 李冬妹   

  1. 北京市红十字血液中心HLA实验室,北京 100088
  • 收稿日期:2024-03-08 出版日期:2024-06-20 发布日期:2024-06-24
  • 通讯作者: 李冬妹,主要从事血液免疫学相关研究工作,（E-mail）30221188@qq.com。
  • 作者简介:范成艳,主要从事输血医学和HLA分型方面工作,（E-mail）fanchengling2001@163.com。
  • 基金资助:
    *本研究受北京市红十字血液中心中心级课题（No.BRCBC2021-03）资助

Analysis of HLA/HPA Antibody Specificity and Its Impact on Platelet Transfusion Outcomes in Patients with Immune Platelet Transfusion Refractoriness

FAN Chengyan, WEN Yujie, ZHANG Dan, LIAN Xue, LIU Na, SUN Tiecheng, WANG Dongmei, JIA Yanjun, LI Dongmei   

  1. Department of HLA, Beijing Red Cross Blood Center, Beijing 100088
  • Received:2024-03-08 Online:2024-06-20 Published:2024-06-24

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摘要： 目的 探讨免疫性血小板输注无效（PTR）患者HLA/HPA抗体特异性分布特征及其对血小板输注效果的影响。方法 本研究以86例免疫性PTR患者为研究对象,收集其性别、年龄、身高、体重、配血次数、疾病类型、输注前后血小板计数等临床资料,通过微珠法进行HLA特异性抗体的检测,并分析抗体特性对血小板输注效果的影响。结果 86例PTR患者中,单独HLA抗体、单独HPA抗体、HLA+HPA抗体阳性的患者分别为72例（83.72%）、8例（9.30%）、6例（6.98%）。HLA抗体在各位点中检出频率最高的抗体对应等位基因分别为A*25:01、B*15:12、C*02:02（和C*17:01）,检出率分别为81.48%、87.04%、48.15%;而对应抗原表位出现频率最高的前三位为163LG、97V、71ATD,检出率分别为87.04%、77.78%、74.07%。仅存在HLA抗体的患者,输注交叉配型相合血小板的24 h血小板计数纠正增加指数（CCI）及输注有效情况均明显优于随机血小板（P<0.01）。在血小板交叉配型阴性结果的患者中,HLA抗体强度与交叉配型相合血小板的24 h CCI值及输注有效情况呈负相关关系,强度越高,输注效果越差（P<0.01）。HLA抗体强度为中、低等水平的患者,输注交叉配型相合血小板的24 h CCI值及输注有效情况均优于输注随机血小板（P<0.05）。结论 本研究所得到的PTR患者HLA/HPA抗体特性及其对血小板输注效果影响的结果,可为血小板库建立时供者的选择提供指导,同时对临床PTR患者的治疗方式选择有一定的参考价值。

关键词: 免疫性血小板输注无效, HLA抗体, HPA抗体, 抗体分布特征, 24 h血小板计数纠正增加指数

Abstract: Objective To analyze the distribution of HLA/HPA antibody specificity and its influence on the efficacy of platelet transfusion in patients with immune platelet transfusion refractoriness（PTR）. Methods In this study, 86 patients with immune PTR were recruited, and clinical data were collected, including gender, age, height, weight, times of platelet cross-matching, diseases, as well as platelet count before and after platelet transfusion. HLA antibody specificity was determined using the microbead assay. Results Among 86 PTR patients, 72 (83.72%) had HLA antibodies alone, 8 (9.30%) had HPA antibodies alone, and 6 (6.98%) had both HLA and HPA antibodies. The most prevalent HLA alleles corresponding to HLA antibodies in different loci were A*25:01, B*15:12, C*02:02 (and C*17:01), with the positive rates of 81.48%, 87.04%, and 48.15%, while the top antigenic epitopes were 163LG, 97V, and 71ATD, with the positive rates of 87.04%, 77.78%, and 74.07%, respectively. In patients with HLA antibodies alone, cross-matched platelet transfusions showed significantly higher 24 h corrected count increment（CCI）and transfusion efficiency than randomized transfusions (P<0.01). In patients with negative cross-matching results, the intensity of HLA antibodies inversely correlated with both the 24 h CCI and the effective rate of platelet transfusion in patients receiving cross-matched platelets. Specifically, a higher the level of HLA antibodies corresponded to a lower 24 h CCI and reduced transfusion efficiency (P<0.01). Conversely, in patients with a lower level of HLA antibodies, the efficiency of platelet transfusion and 24 h CCI of cross-matched platelets were significantly higher than those of randomized platelets (P<0.05). Conclusion Our findings reveal the specificity of HLA/HPA antibodies in patients with immune PTR and their effect on platelet transfusion efficacy, which would provide guidance for donor selection in the establishment of platelet banks. Furthermore, this study could also provide a reference for selecting appropriate treatment strategies for patients with immune PTR.

Key words: Immune platelet transfusion refractoriness（PTR）, HLA antibody, HPA antibody, Antibody distribution characteristics, 24 h corrected count increment（CCI）

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