肿瘤患者血小板输注疗效影响因素及HLA-Ⅰ类抗体特异性分析

Factors affecting the efficacy of platelet transfusion and specificity of HLA-Ⅰantibodies in tumor patients

目的分析肿瘤患者血小板输注疗效影响因素及HLA-Ⅰ类抗体特异性。方法对四川省肿瘤医院2019年11月至2021年7月期间申请血小板输注的142名肿瘤患者筛查血小板抗体、判定输注疗效并分析其影响因素,对抗体阳性者检测并鉴定HLA-Ⅰ类抗体。结果肿瘤患者血小板抗体阳性率、HLA-Ⅰ类抗体阳性率及输注无效率为35.2%(50/142)、32.4%(46/142)及16.9%(24/142)。血小板抗体阳性者输注无效率为30.0%(15/50),高于血小板抗体阴性者[9.8%(9/92)](χ^(2)=9.428,P<0.05)。多因素Logistics结果显示性别(χ^(2)=12.608,P<0.001,OR=3.800,95%CI:1.819~7.940)为血小板抗体产生独立危险因素,血小板抗体(χ^(2)=8.648,P<0.05,OR=3.952,95%CI:1.581~9.878)为输注疗效独立危险因素。强阳性、阳性及弱阳性HLA-Ⅰ类抗体检出率为69.6%(32/46)、80.4%(37/46)及97.8%(45/46),检出率最高的抗体为抗-B*15∶12、抗-B*57∶03、抗-B*57∶01、抗-B*13∶02、抗-B*49∶01、抗-B*50∶01、抗-A*25∶01、抗-B*15∶01、抗-B*15∶02、抗-B*44∶02。MFI均值≥10000的HLA-Ⅰ类抗体共19种,包含抗-A*02∶01、抗-A*02∶03、抗-A*02∶06等。Wilcoxon检验示HLA-Ⅰ类抗体阳性者(n=46)CCI值低于HLA-Ⅰ类抗体阴性者(n=96)(P<0.05)。结论输注血小板的肿瘤患者中,女性为血小板抗体产生危险因素,血小板抗体阳性者容易发生输注无效,HLA-Ⅰ类抗体是主要的血小板抗体,提示HLA-Ⅰ基因配合型血小板能够改善输注疗效。

Objective To analyze the factors affecting the efficacy of platelet transfusion and the specificity of HLA-Ⅰantibodies in tumor patients.Methods Tumer patients applied for platelet transfusion from November 2019 to July 2021 in Sichuan Cancer Hospital province were screened for platelet antibodies.The transfusion efficacy was evaluated and its influencing factors were analyzed,Antibody positive patients were detected for HLA-Ⅰantibodies.Results The positive rates of platelet antibody and HLA-Ⅰantibody,as well as the platelet transfusion refractoriness rate were 35.2%(50/142),32.4%(46/142)and 16.9%(24/142),respectively.The platelet refractoriness rate of platelet antibody positive patients was higher than that of platelet antibody negative patients[30.0%(15/50)vs 9.8%(9/92)](χ^(2)=9.428,P<0.05).Multivariate logistic results showed that gender(χ^(2)=12.608,P<0.001,OR=3.800,95%CI:1.819-7.940)was an independent risk factor for platelet antibody production,and platelet antibody(χ^(2)=8.648,P<0.05,OR=3.952,95%CI:1.581~9.878)was the independent risk factor for transfusion efficacy.The detection rates of strong positive,positive and weak positive HLA-I antibodies were 69.6%(32/46),80.4%(37/46)and 97.8%(45/46),respectively.The antibodies with high detection rate were anti-B*15∶12,anti-B*57∶03,anti-B*57∶01,anti-B*13∶02,anti-B*49∶01,anti-B*50∶01,anti-A*25∶01,anti-B*15∶01,anti-B*15∶02 and anti-B*44∶02.There were 19 kinds of HLA-Ⅰantibodies with MFI≥10000,including anti-A*02∶01,anti-A*02∶03 and anti-A*02∶06.The CCI values were lower in HLA-Ⅰantibody positive patients(n=46)than in HLA-I antibody negative patients(n=96)by Wilcoxon test(P<0.05).Conclusion Among tumor patients who received platelet transfusion,gender(female)was the risk factor for platelet antibody production.Platelet antibody positive patients were prone to platelet transfusion refractoriness.HLA-Ⅰantibodies were the main platelet antibodies,suggesting that HLA-Ⅰgene matching platelets could improve the efficacy of platelet transfusion.