Analysis of unexpected antibody screening in patients before blood transfusion in a medical center
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摘要: 目的 分析单中心患者输血前血浆中意外抗体筛查阳性率和分布情况。方法 统计2016—2020年意外抗体筛查人次及其阳性病例，并随机抽取同一时段意外抗体筛查阴性病例，通过回顾性病例对照研究分析意外抗体筛查阳性率在不同性别、输血史和妊娠史以及不同疾病中的分布情况，同时对意外抗体的消逝和持续性进行分析。结果 调查时间段内进行意外抗体筛查219 386人次，其中1 488人次为阳性，阳性率为0.68%；选取意外抗体阳性的1 147例患者作为观察组，随机抽取同时段意外抗体筛查阴性的1 159例患者作为对照组，单因素分析显示，意外抗体阳性率在性别、输血史、血液疾病、自身免疫性疾病、肿瘤、肝脏疾病、心脏疾病等方面，差异有统计学意义(P < 0.05)；多因素分析显示输血史、血液疾病、自身免疫性疾病和肝脏疾病为意外抗体产生的影响因素(P < 0.05)；1 147例意外抗体筛查阳性患者中42例转变为阴性，消逝率为3.66%(42/1 147)；意外抗体消逝率在血液疾病患者中显著高于非血液疾病(P < 0.05)；消逝的中位时间为109 d。结论 有输血史、血液疾病、自身免疫性疾病和肝脏疾病患者产生意外抗体的风险较高，建议此类患者在输血期间增加抗体筛查的频率；随着抗体的消逝，输血风险增加，建议为曾经检出过意外抗体的患者建立同种免疫档案，保证输血安全。Abstract: Objective To analyze the prevalence and distribution of unexpected antibody screening in patients before blood transfusion in a medical center.Methods The number of unexpected antibody screening cases and their positive cases in our hospital from 2016 to 2020 was counted, and the negative cases of unexpected antibody screening were randomly selected during the same period. A retrospective case-control study was conducted to analyze the prevalence and distribution of unexpected antibody screening among the patients with several clinical conditions including different genders, the history of blood transfusion and pregnancy, and different diseases. The evanescence and persistence of these positive unexpected antibodies were analyzed at the same time.Results Among a total of 219 386 cases, 1 488 cases(0.68%) had positive results for unexpected antibody screening tests during the investigation period. 1 147 patients who were positive for unexpected antibodies were selected as the observation group, and 1 159 patients with negative unexpected antibodies screening in the same period were randomly selected as the control group. Univariate analysis showed that there were statistically significant differences in the positive rate of unexpected antibody screening among the patients with different genders, the history of blood transfusion, blood diseases, autoimmune diseases, tumors, liver diseases and heart diseases(P < 0.05). Multivariate analysis showed that the history of blood transfusion and blood diseases, autoimmune diseases and liver diseases were the influencing factors of unexpected antibody positivity(P < 0.05). The tested results from 42 patients with positive unexpected antibodies screening turned negative, and the evanescence rate of unexpected antibodies was 3.66%(42/1 147). The evanescence rate of unexpected antibodies was significantly higher in the patients with blood disorders than those with non-blood disorders(P < 0.05). The median days of the evanescence of unexpected antibodies was 109.Conclusion Patients with several clinical conditions including the history of blood transfusion, blood disorders, autoimmune diseases, and liver diseases may be at increased risk for unexpected antibodies, and be advised to increase the frequency of antibody screening during blood transfusion. It is recommended to establish alloimmunological records for patients with unexpected antibodies to ensure the safety of blood transfusion.
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表 1 意外抗体阳性患者的单因素分析
例(%) 变量 分组 例数 意外抗体 χ2 P 阳性组 阴性组 性别 男 894 357(39.9) 537(60.1) 56.169 < 0.001 女 1 412 790(55.9) 622(44.1) 输血史 有 584 361(61.8) 223(38.2) 45.615 < 0.001 无 1 722 786(45.6) 936(54.4) 妊娠史 有 1 237 704(56.9) 533(43.1) 3.755 0.053 无 175 86(49.1) 89(50.9) 自身免疫性疾病 有 162 144(88.9) 18(11.1) 106.823 < 0.001 无 2 144 1 003(46.8) 1 141(53.2) 血液疾病 有 182 143(78.6) 39(21.4) 65.703 < 0.001 无 2 124 1 004(47.3) 1 120(52.7) 肿瘤 有 561 244(43.5) 317(56.5) 11.569 0.001 无 1 745 903(51.7) 842(48.3) 肝脏疾病 有 316 184(58.2) 132(41.8) 10.553 0.001 无 1 990 963(48.4) 1 027(51.6) 心脏疾病 有 245 100(40.8) 145(59.2) 8.731 0.003 无 2 061 1 047(50.8) 1 014(49.2) 胰腺疾病 有 50 19(38.0) 31(62.0) 2.818 0.093 无 2 256 1 128(50.0) 1 128(50.0) 外伤 有 317 146(46.1) 171(53.9) 1.994 0.158 无 1 989 1 001(50.3) 988(49.7) 肾脏疾病 有 200 102(51.0) 98(49.0) 0.139 0.709 无 2 106 1 045(49.6) 1 061(50.4) 
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表 2 意外抗体阳性患者的logistic回归分析
变量 P OR 95%CI 性别 0.097 1.336 0.949~1.883 输血史 < 0.001 1.662 1.341~2.059 自身免疫性疾病 < 0.001 7.818 4.686~13.042 血液疾病 < 0.001 4.185 2.836~6.175 肿瘤 0.266 0.888 0.721~1.095 肝脏疾病 < 0.001 1.615 1.247~2.093 心脏疾病 0.123 0.793 0.590~1.065
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表 3 意外抗体消逝相关因素分析
例(%) 变量 分组 例数 意外抗体阳性 χ2 P 消逝组 未消逝组 性别 男 356 15(4.2) 341(95.8) 0.435 0.510 女 789 27(3.4) 762(96.6) 输血史 有 360 16(4.4) 344(95.6) 0.896 0.344 无 785 26(3.3) 759(96.7) 妊娠史 有 704 25(3.6) 679(96.4) 0.329 0.566 无 85 2(2.4) 83(97.6) 自身免疫性疾病 有 144 4(2.8) 140(97.2) 0.370 0.543 无 1 001 38(3.8) 963(96.2) 血液疾病 有 142 10(7.0) 132(93.0) 5.223 0.022 无 1 003 32(3.2) 971(96.8) 肿瘤 有 244 8(3.3) 236(96.7) 0.133 0.715 无 901 34(3.8) 867(96.2) 肝脏疾病 有 184 3(1.6) 181(98.4) 2.576 0.108 无 961 39(4.1) 922(95.9) 心脏疾病 有 100 3(3.0) 97(97.0) 0.138 0.710 无 1 045 39(3.7) 1 006(96.3) 胰腺疾病 有 19 0 19(100.0) 0.736 0.391 无 1 126 42(3.7) 1 084(96.3) 外伤 有 146 8(5.5) 138(94.5) 1.554 0.213 无 999 34(3.4) 965(96.6) 肾脏疾病 有 101 2(2.0) 99(98.0) 0.893 0.345 无 1 044 40(3.8) 1 004(96.2)
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