免疫性血小板输注无效患者血清HLA和HPA抗体强度与输注效果的相关性OA
Correlation between serum HLA and HPA antibody strength and transfusion effect in patients with ineffective immune platelet transfusion
目的 探讨免疫性血小板输注无效患者血清中人类白细胞抗原(HLA)及人类血小板抗原(HPA)抗体变化的临床意义,分析抗体强度及输注次数对血小板输注效果的影响.方法 回顾性纳入95例患者,按抗体类型(HLA型、HPA型、HLA+HPA型)及强度(HLA低/中/高、HPA低/高)分组,对比输注有效率(24 h血小板校正增高指数CCI≤4.5为无效)及CCI水平,分析输注次数与抗体强度相关性.结果 纳入的 95 例患者中,84.21％为HLA抗体阳性,HPA抗体阳性占9.47％,HLA+HPA抗体共占6.32％.HLA型患者中,交叉配型相合血小板输注有效率及24 h CCI水平均显著高于随机血小板输注(P<0.05);HPA型、HLA+HPA型患者中,两种输注方式的有效率及24 h CCI水平对比均无显著差异(P>0.05).随HLA抗体强度增加,交叉配型相合血小板输注有效率及24 h CCI逐渐降低(P<0.05);中、低强度HLA抗体患者交叉配型相合输注有效率及24 h CCI均显著高于随机输注(P<0.05),高强度HLA抗体患者两种输注方式的有效率及24 h CCI无显著差异(P>0.05).随机输注组平均次数显著多于交叉配型组(P<0.05),且随机输注次数与HLA抗体强度呈正相关(P<0.05).结论 HLA抗体强度是影响输注效果的关键因素,交叉配型可提高不同强度HLA抗体患者疗效;反复随机输注可能促进HLA抗体升高,HPA抗体影响需扩大样本验证.
Objective To exploring the clinical significance of changes in human leukocyte antigen(HLA)and hu-man platelet antigen(HPA)antibodies in the serum of patients with ineffective immune platelet transfusion,and to analyze the effects of antibody strength and transfusion frequency on platelet transfusion efficacy.Methods A retro-spective study was conducted on 95 patients,who were grouped according to antibody type(HLA type,HPA type,HLA+HPA type)and intensity(HLA low/medium/high,HPA low/high).The transfusion efficacy rate(defined as a 24-hour corrected count increment[CCI]≤4.5 indicating refractoriness)and CCI level were compared,and the correlation between transfusion frequency and antibody intensity was analyzed.Results Among the 95 patients,84.21％were positive for HLA antibody,9.47％for HPA antibody and 6.32％for HLA+HPA antibody.In HLA patients,the effective rate of cross-matched platelet transfusion and the 24-hour CCI level were significantly higher than those of random platelet transfusion(P<0.05).There was no significant difference in the effective rate and 24-hour CCI level between HPA type and HLA+HPA type patients(P>0.05).With the increase of HLA antibody strength,the effective rate of cross-matched platelet transfusion and 24-hour CCI decreased gradually(P<0.05).The effective rate and 24-hour CCI of cross-matching transfusion in patients with moderate and low-intensity HLA antibodies were significantly higher than those of random transfusion(P<0.05),but there was no significant differ-ence between the two transfusion methods in patients with high-intensity HLA antibodies(P>0.05).The average number of times in random transfusion group was significantly higher than that in cross-matching group(P<0.05),and the number of times of random transfusion was positively correlated with the strength of HLA antibody(P<0.05).Conclusions HLA antibody strength is the key factor affecting the transfusion effect,and cross-matching can improve the curative effect of patients with different HLA antibody strength.Repeated random transfusion may promote the increase of HLA antibody,and the effect of HPA antibody requires validation in large cohorts.
朱文娟;崔凡
芜湖市第一人民医院 输血科,安徽 芜湖 241000芜湖市第一人民医院 检验科,安徽 芜湖 241000
医药卫生
免疫性血小板输注无效HLA抗体HPA抗体抗体强度血小板输注效果
ineffective immune platelet transfusionHLA antibodiesHPA antibodiesantibody strengthplatelet transfusion effect
《基础医学与临床》 2026 (4)
512-516,5
安徽省中央引导地方科技发展专项(201907d07050010)
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