机采血小板储存损伤对临床疗效的影响

Effect of Platelet Storage Lesion on The Clinical Efficacy of Transfusion

目的探讨机采血小板储存损伤与血小板输注临床疗效的关系。方法检测64份机采血小板的血小板聚集功能和P-选择素,对56例血液病患者给予64治疗量机采血小板输注,输注后24h进行外周血血小板计数,根据血小板增高指数(CCI)、血小板回收率(PPR)和出血好转情况判定输注效果,分析血小板储存损伤对其影响的相关性。结果 64治疗量机采血小板输注后,40例输注有效的CCI值为(16.0±5.5),24例无效的CCI值为(3.4±1.0);输注血小板最大聚集率在有效期内第2天～第5天的平均值±标准差(Mean%±SD%)、最小值(min%)～最大值(max%)为48.1±4.7(41.1～56.2)、38.1±3.5(31.2～43.1)、17.4±2.4(14.5～20.9)、9.6±3.3(5.8～19.9);血浆可溶性P-选择素在有效期内第2天～第5天含量(Mean±SD)ng/mL为(11.4±5.8)、(28.9±7.5)、(55.5±8.4)、(89.2±5.6)ng/mL;血小板聚集功能与血小板输注疗效呈正相关(r=0.892,P <0.01),血浆可溶性P-选择素浓度与血小板输注疗效呈负相关(r=-0.836,P <0.01),均有统计学意义。结论机采血小板保存期内的血小板损伤会影响血小板输注无效的发生率,医疗机构可结合临床输注效果制定血小板功能标准和规范,提升本地区的输血水平。

Objective To investigate the relationship between platelet storage lesion and treatment efficacy of platelet transfusion. Methods The platelet aggregation function and P-selectin were measured in 64 patients with hematologic disorders. The platelet recovery rate (PPR),platelet increase index (CCI) and hemostasis were measured for evaluation of transfusion efficacy and the correlation between platelet storage lesion and platelet recovery was analyzed. Results The effective CCI value of platelet transfusion was (16.0±5.5) in 40 patients,the CCI value of 24 cases was (3.4±1.0),the median of maximal platelet aggregation rate(Mean%±SD%),the minimum value (min%)- maximum value (max%) were 48.1±4.7(41.1~56.2),38.1±3.5(31.2~43.1),17.4±2.4(14.5~20.9),and 9.6±3.3(5.8~19.9) from 2d to 5d of validation. The contents of plasma soluble P-selectin (Mean±SD) were (11.4±5.8 ),(28.9±7.5 ),(55.5±8.4 ),and (89.2±5.6 )ng/ mL in the period of validation. A significant positive correlation was seen between platelet aggregation function and platelet transfusion efficacy (r =0.892,P <0.01),while a marked negative correlation between plasma soluble P-selectin concentration and platelet transfusion efficacy (r =-0.836,P <0.01). Conclusion Platelet injury during the period of platelet preservation may affect the incidence of platelet transfusion inefficiency. The transfusion efficacy can be improved by incorporating the functional criteria of apheresis platelets into clinical study.