青岛地区已知HLA和HPA分型血小板供者库的建立及临床应用

Establishment and clinical application of platelet donor registry with known HLA class Ⅰand HPA type in Qingdao area,China

目的建立青岛市已知HLA和HPA分型的无偿机采血小板供者库并用于解决血小板输注无效(PRT)患者的血小板输注。方法采用PCR-SSO流式磁珠法和PCR-SSP法分别对青岛地区无偿机采血小板捐献者1 800人进行HLA-Ⅰ类(A,B位点)、HPA-1—-5,-15基因分型,针对不同免疫状态的PTR患者比较3种不同配型法(血小板随机交叉配型法、抗原特异性配合法、抗原阴性选择法)解决血小板输注无效的效果。结果在高致敏(群体反应性抗体PRA>60%)患者中,HLA和或HPA特异性配型效果较好;轻度致敏(PRA<60%)患者随机交叉,抗原阴性选择,抗原特异性配型方案效果相似。不考虑ABO血型的因素1 800名的血小板供者库可以使99%的患者在库中找到至少1例HLA完全相合的供者,理论估算的供者库规模被不同表型的患者库中检索结果证实。结论理论上青岛本地化已知分型血小板供者库规模需达到6 000人左右可以有效解决血小板输注无效患者的血小板输注问题。只有重度致敏的患者需要HLA完全相同的供者,而轻度致敏的患者可以选择随机交叉配合或抗原阴性选择方案。

Objective To establish a voluntary apheresis platelet donor registry with HLA and HPA typings in Qingdao,in order to resolve the platelet transfusion refractoriness（PTR）.Methods HLA classⅠ and HPA-1 to-5 and-15 system of 1 800 regular apheresis platelet donors in Qingdao region were genotyped by PCR-SSO and PCR-SSP,respectively.The effectiveness of three different platelet selection strategy,i.e.HLA antigen-negative,PLT cross-matching,and HLA specific matching,for alloimmunized PTR patients were compared.Results HLA and or HPA specific matching was better for severely alloimmunized patients（PRA60%）,while for patients with PRA60%,the random cross-matching,antigen-negative selection and antigen-specific matching showed similar effect in treating the PTR.A registry of 1 800 platelet donors would enable more than 99% of patients to get at least one completely matched donor,and this theoretically estimated pool size was validated by the search results of patients with different HLA phenotypes.Conclusion In theory,a registry of about 6 000 local HLA class Ⅰ and HPA-typed platelet donors,is suitable for resolving PTR patients in Qingdao.Only severely alloimmunized patients need the completely matched platelets,while lightly alloimmunized patients can seek such alternatives as crossmatching or antigen-negtive strategy.