多中心联合筛查红细胞血型不规则抗体的大数据分析

Big data analysis of multi-center screening for irregular antibodies of erythrocyte blood group

目的收集血型不规则抗体特异性、阳性率及其在临床输血患者中分布特点的大数据。方法 2016年01月—2017年11月,在5家临床医院采用微柱凝集法对79 403名临床申请输/备血的患者做不规则抗体筛查（抗筛）,对于初筛阳性的患者标本统一送血型参比实验室做抗体特异性鉴定;统计总体阳性率、男女患者阳性比例,不同血型系统不规则抗体检出率以及不同性质抗体所占比例。结果本组患者不规则抗体初筛阳性率0. 64%（507/79403）,确认阳性率0. 51%（409/79 403）。不规则抗体阳性者中,女性与男性分别占72. 13%（295/409） vs 27. 87%（114/409）（P〈0. 01）;有输血或/和妊娠史者占75. 55%（309/409）;妇产疾病和肝脏疾病患者的抗筛阳性比例较高,合计占总抗筛阳性患者的50. 13%（205/409）。Rh血型抗体占53. 79%（220/409）,其中抗-E为36. 43%（149/409）;LEWIS血型抗体占14. 67%（60/409）,其中抗-Le^a为13. 94%（57/409）; MNS血型抗体占7. 09%（29/409）,其中抗-M为6. 36%（26/409）;自身抗体占10. 76%（44/409）,混合抗体占4. 16%（17/409）,Diego血型抗体占4. 65%（19/409）,Kidd血型抗体占2. 20%（9/220）,Duffy血型抗体占1. 46%（6/409）,P血型抗体占0. 49%（2/409）,冷抗体占0. 24%（1/409）;因血清量少,未鉴定出抗体特异性2例,占0. 49%（2/409）。结论所获得的临床申请输/备血的患者不规则抗体及抗体特异性的第一手大数据证明在患者（尤其是有输血史或/和妊娠史的患者）输血前做抗筛的必要性,为临床安全、有效、合理用血提供了科学依据。

Objective To collect the big data on the specificity and positive rate of irregular blood group antibodies and their distribution in clinical blood transfusion patients. Methods During January 2016 to November 2017, 79 403 patients were screened for irregular antibodies by microcolumn agglutination method in 5 clinical hospitals, and the antibody specificity was determined by the blood-type reference laboratory for the patients with positive initial screening. The detection rate of irregular antibodies in different blood group systems and the proportion of antibodies with different properties were analyzed. Results The positive rate of irregular antibody s^reening was 0. 64% （ 507/79 403） and the positive rate of confirmation was 0. 51% （409/79 403）. Among the irregular antibody positive patients, 72. 13% （295/409） vs 27.87% （114/409） （P 〈0. 01）, 75.55% （309/409） had blood transfusion or/or pregnancy history, and 50. 13% had antiscreening positive in maternal and hepatic diseases. Rh blood group antibodies accounted for 53.79% （220/409） , including anti-E 36. 43% （149/409）, LEWIS blood group antibodies 14. 67% （60/409） , anti-Lea 13.94% （57/409）, MNS blood group antibodies 7.09% （29/409）, anti-M 6. 36% （26/409）, autoantibodies 10. 76% （44/409）, mixed antibodies 4. 16% （17/409）; Di- ego Blood group antibodies accounted for 4. 65% （19/409） ; Kidd blood group antibodies accounted for 2. 20% （9/220） ; Duffy blood group antibodies for 1.46% （6/409） ; P blood group antibodies accounted for O. 49% （2/409） ; cold antibodies accounted for 0. 24% （1/409）. Due to the relatively insufficient amount of the sample serum, 2 cases fail to identify antibody specificity, accounting for 0. 49% （2/409）. Conclusion The first-hand data of irregular antibody and antibody specificity of patients who applied for blood transfusion/preparation has proved the necessity of anti-screening before blood transfusion, and provided scientific basis for safe, effective and rational use of blood.