Study on influencing factors of ineffective platelet transfusion in patients with tumor in Xinjiang
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摘要: 目的 探讨新疆地区肿瘤患者血小板输注无效发生的影响因素，分析肿瘤患者血小板输注无效后的预后。方法 收集2021年5月—2021年9月新疆地区医院的135例肿瘤输注血小板患者，按照血小板校正计数增量(CCI)指数将患者分为输血有效组(85例)和输血无效组(50例)。采集病史资料后分别检测血小板表面CD36、淋巴细胞表面CD36、血小板抗体(抗HLA-Ⅰ、HPA抗体)，对结果进行比较分析。输血后2年随访患者生存状态，Kaplan-Meier法绘制生存曲线。结果 输血有效组和无效组比较既往输血袋数、输注血小板有效期及输注血小板是否滤除白细胞差异有统计学意义(P < 0.05)。2组间CD36抗原表达情况差异有统计学意义(χ2=5.747，P=0.033)，不同血小板抗体种类肿瘤患者血小板抗体阳性率差异有统计意义(χ2=14.434，P < 0.001)。对于白血病患者，血小板输注有效组生存率明显高于血小板输注无效组，差异有统计学意义(P < 0.05)。结论 新疆地区肿瘤患者血小板输注无效发生率较高，CD36、血小板抗体及血小板有效期及既往输血袋数等是肿瘤患者血小板输注无效的影响因素。白血病患者发生血小板输注无效对患者生存周期有一定影响。Abstract: Objective To investigate the influencing factors of ineffective platelet infusion in tumor patients in Xinjiang and further analyze the prognosis of patients with tumor after ineffective platelet infusion.Methods 135 patients with platelet transfusion from May 2021 to September 2021 were collected. According to CCI index, the patients were divided into effective group (n=85) and ineffective group(n=50). After collecting medical history data, CD36 on platelet surface, CD36 on lymphocytes surface, anti-HLA-Ⅰantibody and HPA antibody were detected respectively, and the results were compared and analyzed. Two years after blood transfusion, the survival status of the patients was followed up by telephone. The survival curve was drawn by Kaplan-Meier method.Results There were significant differences in the number of blood bags, the validity period of platelet transfusion and the filtration of leukocytes between the effective group and ineffective group(P < 0.05). There was significant difference in the expression of CD36 antigen between the two groups(P＝0.033), and there was significant difference in the positive rate of platelet antibody in the patients with different types of platelet antibody(P < 0.001). The survival rate of leukemic patients with effective platelet infusion was significantly higher than that of ineffective platelet infusion(P < 0.05).Conclusion The incidence of ineffective platelet infusion in tumor patients in Xinjiang was higher than that in other diseases. CD36, platelet antibody, platelet validity period and the number of blood transfusion bags in the past were the influencing factors of platelet infusion inefficacy in tumor patients. The ineffective platelet infusion in leukemia patients had a certain effect on the life cycle of leukemia patients.
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Key words:
- tumor patients /
- ineffective platelet infusion /
- life cycle /
- platelet antibody
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表 1 非免疫因素对肿瘤患者PTR的影响
例(%) 临床特征参数 无效组 有效组 χ2 P 血小板输注患者 50(37.04) 85(62.96) 性别 0.931 0.335 男 29(58.00) 42(49.41) 女 21(42.00) 43(50.59) 疾病诊断 3.127 0.537 白血病 18(36.00) 19(22.35) 肝癌 11(22.00) 21(24.71) 淋巴瘤 6(12.00) 11(12.94) 食管癌 7(14.00) 16(18.82) 胃癌 8(16.00) 18(21.18) 既往输血袋数/袋 19.152 < 0.001 1~5 8(16.00) 34(40.00) 6~10 6(12.00) 16(18.82) 11~19 14(28.00) 24(28.24) ≥20 22(44.00) 11(12.94) 输注血小板有效期/h 21.332 < 0.001 < 24 25(50.00) 13(15.29) 24~ < 48 17(34.00) 35(41.18) 48~96 7(14.00) 35(41.18) >96 1(2.00) 2(23.53) 血小板成分是否滤除白细胞 12.886 < 0.001 去白 17(34.00) 56(65.88) 普通 33(66.00) 29(34.12) 
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表 2 CD36表达及分布情况
例(%) CD36表达情况 例数 无效组 有效组 χ2 P CD36抗原阳性 129(95.56) 45(90.00) 84(98.82) CD36抗原Ⅰ型缺失 2(1.48) 2(4.00) 0 CD36抗原Ⅱ型缺失 4(2.96) 3(6.00) 1(1.18) 合计 135(100.00) 50(37.04) 85(62.96) 5.474 0.033
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表 3 输注血小板肿瘤患者血小板抗体情况分布
例(%) 血小板抗体表达情况 例数 无效组 有效组 χ2 P 血小板抗体阴性 117(86.67) 36(72.00) 81(95.29) 仅HLA阳性 11(8.15) 8(16.00) 3(3.53) 仅HPA阳性 3(2.22) 3(6.00) 0 HLA+HPA阳性 4(2.96) 3(6.00) 1(1.18) 合计 135(100.00) 50(37.04) 85(62.96) 14.434 < 0.001
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