单中心输血前患者意外抗体筛查结果分析

李楠; 李归宁; 甘蕾; 李坚; 鲁学良; 陈凤花

doi:10.13201/j.issn.1004-2806.2023.04.002

单中心输血前患者意外抗体筛查结果分析

- 华中科技大学同济医学院附属协和医院输血科(武汉，430022)

详细信息

通讯作者: 陈凤花，E-mail：chfh100@126.com

中图分类号: R457.1

收稿日期: 2022-08-01

刊出日期: 2023-04-01

Analysis of unexpected antibody screening in patients before blood transfusion in a medical center

- Department of Transfusion Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

More Information

Corresponding author: CHEN Fenghua, E-mail: chfh100@126.com

Received Date: 01 August 2022

Publish Date: 01 April 2023

摘要

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。
- 意外抗体 /
- 抗体筛查 /
- 同种免疫 /
- 消逝 /
- 输血安全 /
- 溶血性输血反应
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.
- unexpected antibody /
- antibody screening /
- alloimmunization /
- evanescence /
- the safety of blood transfusion /
- hemolytic transfusion reaction

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图 1 意外抗体消逝天数分布频率

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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
变量	分组	例数	阳性组	阴性组	χ²	P
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
变量	分组	例数	消逝组	未消逝组	χ²	P
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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