微柱凝胶法在直抗试验及交叉配血试验中的应用

APPLICATION STUDY OF MICROCOLUMN GEL TEST IN DIRECT ANTIGLOBULIN TEST AND CROSS MATCHING

目的比较微柱凝胶卡式法与传统试管法、聚凝胺法在直抗试验(DAT)及交叉配血试验结果的差异。找到更适于临床输血前血型相容性试验的方法,从而进一步提高临床输血安全性,保证患者用血安全。方法 2 312例患者血液样本用卡式法定型后,卡式法和传统试管抗人球蛋白试验进行DAT检测,再用卡式法以及试管法、聚凝胺法对血液样本及献血者血样进行平行交叉配血试验。对于交叉配血主侧阳性的样本进一步鉴定血清中是否存在不规则抗体。最后以试管法作为标准,将三种方法得到结果进行统计学分析,评价卡式法DAT结果,并比较卡式法与聚凝胺法交叉配血检测结果的差异。结果在2 312例样本中,卡式法DAT阳性率为6.78%,以传统试管法作为标准,卡式法DAT敏感性为99.4%,特异性为99.9%,且卡式法的阳性强度与试管法相同或大于试管法的样本占97.4%。卡式法和聚凝胺法进行交叉配血试验主侧特异性分别为99.91%、99.74%,次侧特异性分别为99.45%、99.41%,两种方法的特异性无统计学意义(χ2=1.13,P>0.05;χ2=0.04,P>0.05)。两种方法主侧敏感性均为85.71%,差异无统计学意义;次侧敏感性分别为96.72%和84.43%,差异具有统计学意义(χ2=10.80,P<0.01)。结论以传统试管法作为输血前血型相容性试验的检测标准,卡式法DAT检测敏感性和特异性良好,其操作较传统试管法简便、快捷,且结果的判读易于标准化,影响因素少;卡式法交叉配血试验结果与聚凝胺法相比,次侧敏感性高于聚凝胺法,而且卡式法能够排除临床无意义抗体及自身冷凝集抗体的干扰,能够更有效的提高临床输血安全性。

Objective To find a suitable method for clinical blood group compatible test by comparing the direct antiglobulin test（DAT） and cross matching of the microcolumn gel test{MGT）, test tube Coombs test{TT- Coombs/T） and manual polybrene test（MPT） , and to enhance the safety of clinical blood transfu sion. Methods A total of 2 312 blood samples of patients which were typing by MGT were detected the DAT by MGT and TT - Coombs/T, then detected the cross matching by MGT, MPT and TT- Coombs/T simuhaneously. Identify if the irregular antibodies exist in the serum of the samples which were positive in the cross matching major side or not. The results were statistical analyzed using the results of TT- Coombs/T as the standard. Results The positive rates of DAT by MGT results was 6.78% using the re- suhs of TT- Coombs/T as the standard. The sensitivity and specificity of DAT by MGT were 99.4% and 99.9% respectively. 97.4% of the DAT- positive samples were that the positive intensity of MGT results was not weak than which of the TT- Coombs＇T results. The specificity of the MGT and MPT cross matc- hing major side were 99.91% and 99.74% separately, and the specificity of minor side were 99.45% and 99.41 % separately, there was no significantly statistical difference between the two methods（x^2 = 1.13,P 〉0.05;X^2 = 0. 04,P〉0. 05）. The sensitivity of both of the MGT and MPT cross matching major side was 85.71%, and the sensitivity of minor side were 96.72 % and 84. 43% separately, there was significantly statistical difference between the two methods（x^2 = 10.80, P〈0. 01）. Conclusions The sensitivity and specificity of DAT by MGT are satisfactory as the standard. The MGT is superior to TT - Coombs＇T as it more rapid and simply, and the results reading can be standardization. The sensitivity of the minor side of MGT cross matching is significantly sensitive than MPT. The MGT can eliminate the interference from the clinical nonsense antibodies and auto ~ cold agglutinating antibodies, and can enhance more effectively the safety of the clinical blood transfusion.