血小板特异性抗体及HLA抗体引起血小板输注无效的研究

The Platelet GP Specific Antibodies and HLA Antibodies in PTR Patients

目的分析血小板输注无效(PTR)患者血小板同种抗体,并对其HPA及HLA-Ⅰ类抗原进行基因分型,探讨血小板输注无效与血小板同种抗原/HLA-Ⅰ类抗原相关性。方法应用ELISA方法对17例血小板输注无效患者血清中的血小板抗体进行检测;运用PCR-SSP方法,采用HPA分型试剂盒检测血小板同种抗原7个抗原系统HPA-1、2、3、4、5、6、15,以及HLA分型试剂盒对HLA-A/B抗原进行基因分型。结果6名患者单独表达HLA抗体,4名患者表达血小板特异性糖蛋白抗体,3例HLA抗体和血小板特异性糖蛋白抗体共同表达,其中以GPⅡb/Ⅲa为主。对17例患者HPA系统和HLA-Ⅰ类抗原基因分型,发现HPA-3系统中a的基因频率高达0.676,b为0.324;HLA-A*02、HLA-A*24、HLA-A*11和HLA-B*60、HLA-B*13、HLA-B*46多见。结论HLA抗体和血小板特异性糖蛋白抗体表达引起血小板输注无效,了解PTR与HPA/HLA-Ⅰ类抗原的相关性对指导临床血小板配合性输注具有重要意义。

Objective To study the level of the anti-platelet antibodies in platelet transfusion refractoriness （PTR） patients and their genotypes of HPA and HLA- Ⅰ antigen. Methods 17 PTR patients were selected. PCR-SSP assay was used to detect single-nucleotide polymorphism or deletion in HPA and HLA systems. The platelet GP specific antibodies and HLA antibodies in serum were tested with a solid phase ELISA. Results There were 6 patients only expressed HLA antibodies and 4 patients expressed the platelet GP specific antibodies in serum, with the highest frequency of GPⅡ b/Ⅲ a. The gene frequencies obtained from 17 PTR patients were 0.676 and 0.324 for HPA-3a and-3b, respectively; the frequency of HLA-A＊02, A＊24, A＊11, and HLA-B＊60, B＊13 and B＊46 were high in PTR patients. Conclusion The level of platelet GP specific antibodies and the HLA-A and HLA-B specific alleles may be correlated with platelet transfusion refractoriness.