HLA抗体的变化对血小板输注效果的影响

Study on the effect of the changes of anti-HLA antibodies on platelets transfusion

目的 探讨血小板增加修正值 ( correct count index,CCI)无效患者体内 HLA抗体的变化对临床血小板( platelet,PLT)输注效果的影响。方法 采用 ELISA法对 90例 CCI无效患者进行 HLA抗体强度检测 ;同时观察输注行交叉淋巴细胞毒试验 ( CDC)配型血小板后患者 CCI的改变。结果 ( 1 ) 90例随机血小板输注无效患者中 ,HLA抗体阳性率为63 .3 % ,强度在 1 0 %～ 92 %之间 ;( 2 )未成年组与成年组之间 HLA抗体阳性率的差异有显著性 ( P<0 .0 1 ) ;( 3 )输注 CDC配型血小板后 ,5 7例 HLA抗体阳性患者中 CCI有效 5 2例 ( 91 .2 % ) ,3 3例 HLA抗体阴性患者中 CCI有效 1 5例 ( 4 5 .5 % ) ,两者间差异有显著性 ( P<0 .0 1 ) ;( 4 )动态观察 5例长期输注 CDC配型血小板患者 ,其 HLA抗体强度随输注血小板次数的增加而逐渐减弱甚至逆转。结论 当患者出现随机血小板输注无效时 ,应首先检测其 HLA抗体并输注 CDC配型血小板 ;如 HLA抗体阴性应同时考虑使血小板破坏或消耗增加的非免疫因素 ;对于长期输注血小板的患者 ,应动态观察 HLA抗体的变化 ,预测临床血小板输注效果。

Objective To analyze the clinical effect of the changes of anti-HLA antibodies in patients with refracto-riness to random platelets transfusion.Methods The anti-HLA antibodies in 90 patients who were refractory to random-donor platelets were detected by ELISA assay. The change of CCI was observed after complement-dependent cytotoxicity (CDC) crossmatching platelets transfusion.Results In all 90 patients, 57(63%) patients were anti-HLA antibody positive (antibody strength:10%～92%). There was significant difference in the antibody positive rate between the children and the adults groups(P<0.01). After CDC crossmatching platelets transfusion, 52(91.2%) patients among 57 patients with anti-HLA antibodies had satisfactory increments (one-hour post-transfusion CCI>10×10 9/L),while 15(45.5%) of 33 patients hadn′t satisfactory increments of antibody. There was a significant difference between these two groups (P<0.01). In 5 patients who needed chronic platelets transfusion, the strength of antibody weakened with the increment of the crossmatch-compatible platelets.Conclusions When patients are refractory to platelets transfusion, the anti-HLA antibodies should be detected first and CDC crossmatching platelets transfusion is needed. The non-immunologic factors which could lead to the increment of platelet destruction and consumption should be focused for patients without HLA antibodies. The continuous detection of the anti-HLA antibodies is suggested for the patients who need chronic platelets transfusion.