不同血液病患者预存抗人类白细胞抗原抗体阳性率与分布特征

Positive rates and distribution characteristics of pre-existing anti-human-leukocyte-antigen antibodies in patients with different hematological diseases

回顾性收集2016至2018年拟接受异基因造血干细胞移植,并在苏州大学附属第一医院第1次进行抗人类白细胞抗原(HLA)抗体检测的1494例血液病患者的临床资料,在不同血液病患者中分析不同类型预存抗HLA抗体的阳性率及分布特征。1494例血液病患者中,男849例,女645例,年龄[M(Q_(1),Q_(3))]为31(17,45)岁;包括急性髓系白血病(AML)577例,急性淋巴细胞白血病(ALL)373例,再生障碍性贫血(AA)234例,骨髓增生异常综合征(MDS)175例,其他疾病135例。预存抗HLA抗体的总阳性率为25.1%(375/1494),其中抗HLA-Ⅰ类、抗HLA-Ⅱ类和抗HLA-Ⅰ+Ⅱ类抗体的阳性率分别为11.2%(168/1494)、4.9%(73/1494)和9.0%(134/1494)。MDS、AA、AML、ALL、其他患者的预存抗HLA抗体总阳性率分别为40.6%(71/175)、30.8%(72/234)、26.2%(151/577)、12.3%(46/373)和25.9%(35/135),差异有统计学意义(P<0.001)。抗HLA-Ⅰ类、抗HLA-Ⅱ类和抗HLA-Ⅰ+Ⅱ类抗体在不同血液病患者中的阳性率差异均有统计学意义(均P<0.001)。鉴于不同血液病患者预存抗HLA抗体的阳性率和分布特征不同,在接受造血干细胞移植前应进行抗HLA抗体检测。

Clinical data of 1494 patients with hematological diseases who were scheduled to receive allogeneic hematopoietic stem cell transplantation and received the anti-human-leukocyte-antigen(HLA)antibody test for the first time at the First Affiliated Hospital of Soochow University from 2016 to 2018 was collected to analyze the positive rates and distribution characteristics of different types of pre-existing anti-HLA antibodies in patients with different hematological diseases.Among 1494 patients with hematological diseases,there were 849 males and 645 females,aged[31(17,45)]years,and included 577 cases of acute myeloid leukemia(AML),373 cases of acute lymphocytic leukemia(ALL),234 cases of aplastic anemia(AA),175 cases of myelodysplastic syndrome(MDS),and 135 cases of other diseases.The total positive rate of pre-existing anti-HLA antibodies was 25.1%(375/1494),among which the positive rates of anti-HLA classⅠ,anti-HLA classⅡ,and anti-HLA classⅠ+Ⅱantibodies were 11.2%(168/1494),4.9%(73/1494),and 9.0%(134/1494),respectively.The total positive rates of pre-existing anti-HLA antibodies in patients with MDS、AA、AML、ALL and other diseases were 40.6%(71/175),30.8%(72/234),26.2%(151/577),12.3%(46/373),and 25.9%(35/135),respectively,with statistically significant difference(P<0.001).The positive rates of anti-HLA classⅠ,anti-HLA classⅡ,and anti-HLA classⅠ+Ⅱantibodies in patients with different hematological diseases showed statistically significant differences(all P<0.001).Given the varying positive rates and distribution characteristics of pre-existing anti-HLA antibodies among patients with different hematological diseases,anti-HLA antibody test should be performed before receiving hematopoietic stem cell transplantation.