不同临床科室患者红细胞血型不规则抗体检出情况与分析

Analysis of irregular antibody detection among patients in different clinical departments

目的探讨不同临床科室住院患者红细胞血型不规则抗体检出率及其分布情况。方法应用抗球蛋白和微柱凝胶技术对本院2008年1月-2015年1月住院拟输血患者186 534例进行抗体筛查,对阳性结果进一步采用谱细胞进行抗体特异性鉴定。结果共检出抗体阳性2 136例,阳性率为1.15%(2 136/186 534),其中Ig M类抗体848例占39.70%(848/2 136),Ig G类抗体911例占42.65%(911/2 136),Ig M+Ig G类抗体6例占0.28%(6/2136),自身抗体伴同种抗体251例占11.75%(251/2 136),单独自身抗体90例占4.21%(90/2 136),药物性抗体11例占0.51%(11/2 136),非特异性抗体19例占0.89%(19/2 136);此外不同性别患者不规则抗体检出率比较,(χ2=206.76,P<0.01);有既往免疫史患者与无既往免疫史患者不规则抗体检出率比较,(χ2=265.77,P<0.01);以科室为单位统计,不同临床科室患者不规则抗体检出以临床免疫科患者最多占10.64%、其次是肿瘤科患者占3.36%、急诊科患者占2.36%,而血液科患者占1.83%。结论输血前对患者进行不规则抗体筛查和鉴定以及分析,可预先了解患者体内血型抗体产生情况,进一步确保了临床安全用血。

Objective To review and evaluate the detection rates and distribution of irregular erythrocyte antibody among hospitalized patients in different clinical departments. Methods A total of 186 534 hospitalized patients（ 97,905 males and88,629 females） from January 2008 to January 2015 in our hospital were screened for the presence of irregular antibody with antihuman globulin test and micro-gel method. Positive sera were further investigated to identify the specificity of irregular antibody by commercially available red cell panel. Results Among 186 534 patients,2 136 cases or 1. 15%（ 2 136 /186534） were positive for irregular antibody screening,including 39. 70%（ 848 /2 136） for Ig M,42. 65%（ 911 /2 136） for Ig G,0. 28%（ 6 /2 136） for Ig M ＋ Ig G,11. 75%（ 251 /2 136） for autoantibody with alloantibody,4. 21%（ 90 /2 136） for autoantibody alone,0. 51%（ 11 /2 136） for drug-dependent antibody and 0. 89%（ 19 /2 136） for nonspecific antibody. In addition,the positive rate of irregular antibodies between males and females was significantly different by statistical methods（ χ2= 206. 76,P 〈0. 01）. Patients with different prior immunological histories also showed significant difference（ χ2=265. 77,P 〈0. 01）. In disease statistics among different clinical departments,the positive rate of patients with immunological disease accounted for 10. 64%,which was the highest,followed by patients with tumor（ 3. 36%）,emergency treatment（ 2. 36%） and hematopathic disease（ 1. 83%）. Conclusion The positive results for irregular antibody screening were caused by many different factors,including disease,gender and prior immunological history. Therefore,screening and analyzing for the presence of alloantibody in patient blood before blood transfusion is important for understanding the intracorporal situation of patients in advance and ensuring the safety of blood transfusion.