AIHA患者血清中类同种特异性自身抗体的检出率及其分布情况探讨

Investigation on the detection rate and distribution of mimicking autoantibodies with specificity in the serum of AIHA patients

目的探讨自身免疫性溶血性贫血（AIHA）患者血清中类同种特异性自身抗体的检出率及其分布情况，进行回顾性统计与分析。方法应用抗球蛋白和微柱凝胶技术，对2008年1月-2015年12月，在本院住院需要输血的196名AIHA患者，进行输血前相关血型血清学检测，并且利用谱细胞鉴定AIHA患者血清中和红细胞上的抗体，进一步选择合适的抗原细胞，通过吸收放散试验区分同种抗体与类同种特异性自身抗体，同时对检出抗体的患者红细胞进行相应抗原检测。结果196例AIHA患者中，共检出自身抗体伴同种抗体86例占43．9％（86／196），单独自身抗体65例占33．2％（65／196），类同种特异性自身抗体45例占23．0％（45／196）。其中，类同种特异性自身抗体中，Rh血型系统抗原占77．8％（35／45），Kidd血型系统抗原占11．1％（5／45），Rh血型系统抗原混合Kidd血型系统抗体占6．7％（3／45），Duffy血型系统抗原占4．4％（2／45），MNSs血型系统抗原占2．2％（1／45）。此外，不同性别患者类同种特异性自身抗体的检出率比较，差异有统计学意义（X^2=6．00，P〈0．05）。结论AIHA患者类同种特异性自身抗体相当常见，多见于抗Rh血型系统抗原，少数见于Kidd血型系统抗原和Duffy血型系统抗原。了解类同种特异性自身抗体的发生频率和分布规律，为其制订适宜的输血方案，可进一步提高临床输血治疗的安全性和准确性。

Objective To investigate the detection rate and distribution of mimicking specificity autoantibodies in the serum of patients with autoimmune hemolytic anemia （AIHA）. Methods A total of 196 AIHA patients hospitalized in our hospital from January 2008 to December 2015 who needed blood transfusion were selected as participants. Besides the use of standard serologic identification based on anti globulin test and microcolumn gel techniques, antibodies in serum and on the surface of red blood ceils were detected using panel ceils. Then, appropriate cells were selected to distinguish alloantibodiesand mimicking autoantibodies by absorption-elution test. The antigens of the patients who had mimicking antibodies were also tested. Results The positive rate of autoantibodies with alloanti- bodies, autoantibodies alone and mimicking antibodies were 43.9% （86/196）, 33.2% （65/196） and 23.0% （45/196）, respectively. Positive rates of the specificity of mimicking anti- bodies were as followed： Rh antigen （ 77. 8%, 35/45）, Kidd antigen （ 11.1%, 5/45 ）, Rh ＆ Kidd antigen （ 6.7%, 3/ 45）, Dully antigen （4. 4%, 2/45） and MNSs antigen （2. 2%, 1/45）. There was significant difference in the mimicking au- toantibodies detection rate between male and female （X^2 = 6. 00, P〈0. 05）. Conclusion Mimicking autoantibodies with spe- cificity were common in AIHA patients, among which Rh antigen is the most common, while Dully and MNSs antigens were relatively uncommon. Recognizing the incidence rate and distribution of mimicking autoantibodies contributes to making a bet- ter blood transfusion strategy as well as enhancing security and accuracy of clinical blood transfusion treatment.