血小板输注无效患者体内血小板反应性抗体特异性调查研究

Detect and characterize platelet-reactive antibodies in patients who were refractory to platelet transfusions

目的探讨血小板输注无效患者体内血小板反应性抗体的发生频率及其特异性。方法对48名血小板输注无效患者,利用MACE法筛查其血清中的血小板反应性抗体,进一步用PAK12诊断试剂MAIPA法鉴定血小板HPA抗体特异性。结果血小板输注无效患者中血小板反应性抗体的总检出率为50%(24/48),其中同种HLA抗体发生率为39.6%(19/48),占所有抗体检出的79.2%,同种HPA抗体的检出率为29.2%(14/48),而其中有64.3%(9/14)是与HLA抗体同时存在。检出的HPA抗体特异性有抗-HPA-3a(n=2),-5a(n=1),-5b(n=1),-2b(n=1),-4b(n=1);同时HPA抗体中有78.6%(11/14)是针对GPⅡb/Ⅲa,Ⅰa/Ⅱa和/或Ⅰb/Ⅸ的多反应性抗体。女性患者中检出抗体的比例55.2%(16/29)高于男性患者42.1%(8/19),但差异没有显著性统计学意义。结论血小板输注无效患者中血小板同种抗体以HLA抗体多见,但HPA抗体并不像之前报道的罕见。与高加索人群PTR患者血小板同种反应性抗体以抗-HPA-5b,-1b为主不同,研究发现中国人群PTR患者HPA同种抗体以HPA-3,-5系统抗体多见,同时检出了HPA-4b,-2b抗体。

Objective To detect and determine the specificity of platelet-reactive antibodies in patients who were refractory to platelet transfusions. Methods Serum samples from 48 patients who were refractory to platelet transfusions were screened with MACE for platelet-reactive antibodies. Specificity of platelet alloantihodies was determined with PAK12 and MAIPA. Results Platelet-reactive antibodies were detected in the serum of 50% FIR patients （ 24/48 ）. The incidence of HLA antibodies was 39. 6% （ 19/48 ）, accounting for 79. 2% of serum with platelete alloantibodies. The HPA aUoantihodies were found in 29. 2% （14/48）serum ,of which ,64. 3% （9/14） occurrod together with anti-HLA. The following platelet-specific antibodies were identified： anti-HPA-3a（ n = 2 ） , anti-HPA-Sb （ n = 1 ）, anti-HPA-Sa （ n = 1 ）, anti-HPA-2b （ n = 1 ） , anti-HPA-4b（ n = 1 ）. Of the 14 serum with HPA antibodies ,78. 6% （11/14 ） contained panreactive anibodios against platelet glycoprotein（GP） Ⅱ b/Ⅲa,GP Ⅰ a/Ⅱ a,and/or GP Ⅰb/Ⅸ. Platelet-reacfive antibodies were detected more in female（ 16/ 29 ） than in male （ 8/19 ） with a frequency of 55.2%, 42. 1%, respectively, but there was no statistical significant difference. Conclusion The platelet-specific antibody in PTR patients are not as rare as previous thought although alloantihodies are predominantly anti-HLA. Antibody specificities in Chinese FIR patients are different from those observed in Caucasians,in whom anti-HPA-Sb and-1b are the most prevalent specificity. The most prevalent platelet-specific antibodies are anti-HPA-3 and anti-HPA-5 while anti-HPA-4h and anti-HPA-2b are also detected.