摘要
目的分析血小板输注无效(platelet transfusion refractoriness,PTR)患者中人类白细胞抗原(human leucocyte antigen,HLA)抗体和人类血小板抗原(human platelet antigen,HPA)抗体的分布情况以及PTR患者的HPA基因频率。方法选取2020年1—12月北京市红十字血液中心86例因PTR进行血小板抗体检测的血液系统疾病患者,包括急性髓细胞性白血病(acute myelogenous leukemia,AML)、慢性髓细胞性白血病(chronic myelogenous leukemia,CML)、急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)、慢性淋巴细胞白血病(chronic lymphoblastic leukemia,CLL)、骨髓增生异常综合征(myelodysplastic syndrome,MDS)、再生障碍性贫血(aplastic anemia,AA)、特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP),采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)分析其血清中HLA抗体和HPA抗体,采用序列特异引物引导的聚合酶链反应(polymerase chain reaction,PCR)对患者进行HPA-1~6、9及l5系统的基因分型。结果86例患者中有33例的血清显示血小板相关抗体阳性,阳性率为38.4%,其中24例(27.9%)只表达HLA抗体,6例(7.0%)只表达HPA抗体,3例(3.5%)共同表达HLA抗体和HPA抗体。不同疾病之间血小板抗体的发生率比较,差异无统计学意义(P>0.05)。HPA基因分型结果显示,HPA-3和HPA-15具有较高的多态性,HPA-3系统中a的基因频率高达61.5%,b为38.5%;HPA-15中a的基因频率为54.2%,b为45.8%。结论HLA和(或)HPA抗体的产生是导致PTR的重要因素,其中HLA抗体占主要地位,这些患者的HPA基因多态性分布特征与中国北方汉族人群的HPA分布特征一致,确定PTR患者的抗体特异性及HPA基因分布特征将为血小板库的建立提供数据支持。
Objective To analyze the distribution of human leucocyte antigen(HLA)and human platelet antigen(HPA)antibodies in patients with platelet transfusion refractoriness(PTR)and the frequency of HPA genes in patients with PTR.Methods From January to December 2020,86 patients with hematological diseases in the Beijing Red Cross Blood Center,who underwent platelet antibody detection due to PTR were enrolled,including acute myelogenous leukemia(AML),chronic myelogenous leukemia(CML),acute lymphoblastic leukemia(ALL),chronic lymphoblastic leukemia(CLL),myelodysplastic syndrome(MDS),aplastic anemia(AA),idiopathic thrombocytopenic purpura(ITP).The serum antibodies against HLA and HPA were analyzed by enzyme linked immunosorbent assay(ELISA).Hpa-1-6,9 and 15 systems were genotyped using polymerase chain reaction(PCR)guided by sequence specific primers.Results Among the 86 patients,33(38.4%)were positive for platelet-related antibodies,including 24(27.9%)only expressing HLA antibodies,six(7.0%)only expressing HPA antibodies,and three(3.5%)co-expressing HLA and HPA antibodies.There was no significant difference in the incidence of platelet antibody among different diseases(P>0.05).HPA genotyping showed that HPA-3 and HPA-15 were highly polymorphic.The gene frequency of a in HPA-3 system was 61.5%,and that of b was 38.5%.The gene frequency of a and b in HPA-15 was 54.2% and 45.8% respectively.Conclusions The production of HLA and/or HPA antibodies is an important factor leading to PTR,in which HLA antibodies is the main factor.The distribution characteristics of HPA gene polymorphism of these patients are consistent with those of the Han population of northern China.The determination of antibody specificity and HPA gene distribution characteristics of patients with PTR would provide data support for the establishment of platelet bank.
作者
王洁
敬媛媛
李冬妹
王东梅
贾延军
Wang Jie;Jing Yuanyuan;Li Dongmei;Wang Dongmei;Jia Yanjun(HLA Lab,Beijing Red Cross Blood Center,Beijing 100088,China)
出处
《北京医学》
CAS
2021年第12期1215-1218,共4页
Beijing Medical Journal
