CAJ | 학술논문

目的探讨佛山地区血小板输注无效(PTR)患者血小板(PLT)抗体特异性、抗体阳性率及其相关因素,为制定PLT输注策略提供参考依据.方法选择2012年1月至2013年8月,佛山地区5所医院收治的55例PTR患者作为研究对象(本研究遵循的程序符合各病例收集医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象的知情同意,并与之签订临床研究知情同意书).采用固相凝集法检测PTR患者血清中的PLT抗体.计算PLT同种抗体检出率和人类白细胞抗原(HLA)、人类血小板抗原(HPA)抗体阳性率,并分析年龄和输血次数对PLT抗体阳性率的影响.结果 PTR患者PLT同种抗体检出率为58.2％ (32/55),其中同种HPA抗体阳性率为21.8％ (12/55),同种HLA抗体阳性率为50.9％(28/55),抗-HLA占所有免疫性抗体的87.5％ (28/32);在检出HPA抗体的患者中有66.7％(8/12)的患者同时检出HLA抗体.PLT自身抗体阳性率为7.3％(4/55).女性患者中PLT抗体阳性率为60.61％(20/33),略高于男性的54.5％(12/22),但两者比较差异无统计学意义(x2=0.01,P＞0.05).PLT抗体阳性率随输血次数增加而呈增高趋势(x2趋势=13.14,P＜0.05),以输血次数为4～6次时增幅最大.结论佛山地区PTR患者中PLT同种抗体以HLA抗体多见,其次为HPA抗体,少数患者还存在PLT自身抗体;PLT同种抗体阳性率随输血次数增加呈增高趋势,而与患者性别无关.
목적 탐토불산지구혈소판수주무효(PTR)환자혈소판(PLT)항체특이성、항체양성솔급기상관인소,위제정PLT수주책략제공삼고의거.방법 선택2012년1월지2013년8월,불산지구5소의원수치적55례PTR환자작위연구대상(본연구준순적정서부합각병례수집의원인체시험위원회제정적윤리학표준,득도해위원회비준,병정득수시대상적지정동의,병여지첨정림상연구지정동의서).채용고상응집법검측PTR환자혈청중적PLT항체.계산PLT동충항체검출솔화인류백세포항원(HLA)、인류혈소판항원(HPA)항체양성솔,병분석년령화수혈차수대PLT항체양성솔적영향.결과 PTR환자PLT동충항체검출솔위58.2％ (32/55),기중동충HPA항체양성솔위21.8％ (12/55),동충HLA항체양성솔위50.9％(28/55),항-HLA점소유면역성항체적87.5％ (28/32);재검출HPA항체적환자중유66.7％(8/12)적환자동시검출HLA항체.PLT자신항체양성솔위7.3％(4/55).녀성환자중PLT항체양성솔위60.61％(20/33),략고우남성적54.5％(12/22),단량자비교차이무통계학의의(x2=0.01,P＞0.05).PLT항체양성솔수수혈차수증가이정증고추세(x2추세=13.14,P＜0.05),이수혈차수위4～6차시증폭최대.결론 불산지구PTR환자중PLT동충항체이HLA항체다견,기차위HPA항체,소수환자환존재PLT자신항체;PLT동충항체양성솔수수혈차수증가정증고추세,이여환자성별무관.
Objective To detect and determine the correlation factors,specificity and positive rate of platelet (PLT)-reactive antibodies in patients who were refractory to platelet transfusions (RPT) in Foshan area,and to provide a reference basis for formulating marketing strategy of PLT transfusions.Methods From January 2012 to August 2013,55 RPT patients who were inspected by five different hospitals in Foshan area were included in this study.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of these five hospitals.Informed consent was obtained from all participants.Serum samples of these patients were screened with solid-phase agglutination method for PLT-reactive antibodies.The incidence of platelet-reactive antibodies,human leukocyte antigen (HLA)antibodies,human platelet antigens (HPA) antibodies were calculated.Statistical analysis of the correlation factors of the incidence of PLT-reactive antibodies were accomplished.Results Detection rate of PLT-reactive antibodies in RPT patients was 58.2％ (32/55).The incidence of HLA antibodies was 50.9％ (28/55),accounting for 87.5％ (28/32) of serum with PLT isoantibodies.The HPA isoantibodies were found in 21.8％ (12/55) serum,of which 66.7％ (8/12) occurred together with anti-HLA.The PLT-reactive autoantibodies were found in 7.3％ (4/55) serum.PLT-reactive antibodies were detected more in female (20/33) than in male (12/22) with a frequency of 60.6％ and 54.5％,respectively.But there was no statistical significant difference between female and male patents(x2=0.01,P＞0.05).The frequency of occurrence of PLT-reactive antibodies increased along with the number of blood transfusion(x2tramd =13.14,P＜0.05).The greatest increase appeared when the number of blood transfusion were four to six times.Conclusions The PLT-specific antibody in PTR patients is not rare,although isoantibodies are predominantly anti-HLA in Foshan area.Autoantibodies are detected in a few PTR patients.The frequency o occurrence of PLT-reactive antibodies increased along with the number of blood transfusion,but had nothing to do with the patient's gender.