摘要
目的利用血小板供者HLA基因分型库,针对PTR患者建立供受者HLA-A、B位点基因配合型输注策略,以提高临床血小板输注疗效。方法以血清学交叉配合试验作为免疫性PTR的初筛手段,对初筛阳性的35例PTR患者采取血小板基因配型策略,其中24例进行HLA-A、-B基因分型和血小板HLAⅠ类抗体检测,根据患者血小板基因型和供者特异性抗体(DSA)回避策略以及供受者CREG配合等级原则,在单采血小板因型数据库中搜寻配合型供者,其中DSA回避优先于CREG等级原则,共计83次输注。其余11例患者仅按照HLA交叉反应组CREG的配合等级原则选择供受者HLA-A,-B抗原基因型相合的供者,共计55次输注。回访临床患者相关资料及基因配型的血小板输注效果,统计分析校正的血小板计数增值(CCI)。结果对临床送检的35例PTR患者先后进行了453次ABO同型的血清学交叉配合试验,人均为12.94次(453/35),每次血小板交叉配型的供者平均人数为4.21(1908/453)人,血清学交叉配合试验阳性率为69.86%(1333/1908)。其中对24例患者标本进行了HLAⅠ类抗体检测,仅有1例标本为抗体阴性,即HLAⅠ类抗体阳性检出率为95.83%(23/24),且平均每个患者有(44.37±22.31)种特异性抗体;根据患者血清中抗体荧光强度值的高低,抗体为强阳性17例、阳性20例、弱阳性23例,其对应的检出率分别为73.91%(17/23)、86.96%(20/23)和100%(23/23)。138次HLA基因配合型输注后的血小板首次计数CCI均值为14.08±11.12[(23.95±21.28)h],高于1h CCI(>7.5有效)或24h CCI(>4.5有效),且DSA回避组输注效果(首次计数CCI为15.56±11.00)显著优于非DSA回避组(首次计数CCI为11.86±12.00)(P<0.05)。在所有患者输注中,49.28%的输注同时存在1种或多种非免疫因素。结论HLA-I基因配型血小板输注策略是预防和改善免疫相关性血小板输注无效的可行方法,对于多次输血且血小板相关抗体初筛阳性的患者,采取DSA回避和供�
Objective To establish the HLA-A,-B genotype-matched transfusion strategy for immune-mediated PTR patients based on donor HLA genotyping database,so as to improve the transfusion efficacy.Methods The serologic crossmatch was used to screen immune PTR primarily.35 PTR patients screened out were subjected to HLA-match.24 patients were tested for HLA-A,-B genotyping and antibodies against platelet HLA classⅠ,and then received a total of 83 HLA-typed platelet transfusions,based on patient platelet genotype,donor specific antibody(DSA)(priority),and HLA-A,-B cross-reactive groups(CREGs)principle(lower priority).The other 11 patients received a total of 55 HLA-A/B-matched transfusions according to CREGs principle.The clinical information and transfusion outcome were followed up,and the corrected count increment(CCI)was calculated and statistically analyzed.Results A total of 453 ABO serological cross-matching tests were performed for 35 PTR patients,with 12.94 tests(453/35)per patient,an average of 4.21(1908/453)donors per test and positive rate of 69.86%(1333/1908).23 out 24(95.83%)patients,subjected to HLA class I antibody,were positive and each carried(44.37±22.31)kinds of specific antibodies.According to the fluorescence intensity of the antibody in the patient′s serum,the antibody was strongly positive in 17(73.91%)cases,positive 20(86.96%)and weakly positive 23(100%).After 138 HLA-matched transfusions,the first mean CCI value was 14.08±11.12(23.95±21.28 h),which was significant higher than 1 hour CCI(>7.5 effective)or 24 hours CCI(>4.5 effective).The responses of DSA avoidance group(CCI of 1st=15.56±11.00)was significant higher than that of non-DSA avoidance group(CCI of 1st=11.86±12.00)(t=2.045,P<0.05).49.28%of the patients had one or more non-immune factors during platelet transfusion.Conclusion The HLA-matched platelet transfusion is feasible to prevent and improve immune-mediated PTR.For patients with multiple blood transfusions and positive platelet antibodies,DSA avoidance and CREGs principle combi
作者
刘瑛
许先国
马开荣
何吉
朱发明
胡伟
LIU Ying;XU Xianguo;MA Kairong;HE Ji;ZHU Faming;HU Wei(Blood Center of Zhejiang Province,Key Laboratory of Blood Safety Research of Zhejiang Province,Hangzhou 310052,China)
出处
《中国输血杂志》
CAS
2021年第8期832-835,共4页
Chinese Journal of Blood Transfusion
基金
浙江省基础公益研究计划项目(2017C33085,LGF18H080003,LGF19H080004)
浙江医药卫生科技项目(WKJ-ZJ2021,2019KY368)
中华骨髓库科研项目(CMDP201906)。
