摘要:
目的:通过对反复输血（≥3次）患者进行血小板抗体检测,比较阳性与阴性患者血小板输注前后的校正血小板计数增加值（CCI）与血小板输注无效（PTR）发生率,并对阳性PTR患者进行特异性分析,探讨血小板抗体阳性患者的不同抗体阳性率,分析其影响因素,指导后续输注工作。方法:选取2015-06-2016-07收治的反复输血（≥3次）患者156例,均采用微柱凝胶法进行血小板抗体检测,并按照检测结果分为阳性与阴性2组,对2组血小板输注前后的计数进行比较。对阳性患者进行特异性分析,统计其各抗体比例,并分析输血次数与PTR的关系。结果:（1）156例反复输血患者中,54例血小板抗体检查为阳性（34.6%）,其中阳性患者PTR为44例（81.5%）,1h、24h平均CCI为（6.63±1.16）×109/L和（3.01±1.52）×109/L;阴性患者中PTR为11例（10.8%）,1h、24h平均CCI为（15.37±3.22）×109/L和（7.98±3.62）×109/L。（2）对44例血小板抗体阳性的PTR患者进行特异性分析,其中人类白细胞抗原（HLA）抗体33例（75.0%）,血小板特异性抗原（HPA）抗体2例（4.5%）,同时具有HLA与HPA抗体的患者有3例（6.8%）。（3）3~5次输血患者PTR占23.8%;5~10次输血患者PTR占39.3%;10次以上输血患者PTR占39.6%。血小板抗体阳性率及PTR例数等与输血次数呈正相关。结论:反复输血（≥3次）患者中血小板抗体阳性患者引起PTR的比率要远高于阴性患者（P<0.05）,而且PTR的发生跟患者以往输血次数呈正相关,因此对反复输血患者再次输注前进行血小板抗体检测是必要的,对于后续配型输注及节约输注成本具有重要的指导意义。
关键词:
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反复输血
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血小板
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抗体
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分析
Abstract:
Objective:To detect the platelet antibody of the patients with recurrent blood transfusions（≥3times）,compare the incidence of CCI and PTR in positive patients and negative patients before and after platelet transfusion,and analyze the specificity of the positive patients to investigate the positive rate of different antibodies and analyze the influencing factors.Method:A total of 156 cases with recurrent blood transfusions from October 2015 to May 2016 were chosen and platelet antibody was detected by MGT.We divided into two groups with positive and negative patients and compared the incidence of CCI.Then we analyzed the specificity of the positive patients and divided the proportion of each antibody,and studied the relationship between PTR and the number of blood transfusion.Result:（1）There were 54 positive cases（34.6%）,and PTR cases was 44（81.5%）.The 1haverage CCI of the positive patients was（6.63±1.16）×109/L and the 24hwas（3.01±1.52）×109/L.There were 11 PTR cases in the negative patients（10.8%）.The 1haverage CCI of the negative patients was（15.37±3.22）×109/L and the 24hwas（7.98±3.62）×109/L.（2）There had 33 HLA cases（75%）,2HPA cases（4.5%）and 3HLA＆HPA cases（6.8%）.（3）There had 23.8% of patients with 3-5times transfusion of blood,39.3% of patients with 5-10 times transfusion of blood and 39.6% of patients with more than 10 times transfusion of blood.Number of transfusions was positively correlated with the PTR and the positive rate.Conclusion:PTR ratio in the positive patients was much higher than that in the negative patients.We thought it might be caused by immune factors（such as HLA,HPA,etc.）and the number of transfusions was positively correlated with the PTR and the positive rate.So we thought it was necessary to detect the antibody for recurrent blood transfusions（≥3times）in patients before transfusion.
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