某院Rh表型分布及配合性临床输血应用探讨

Application study of Rh phenotype distribution and the management of clinical transfusion in a hospital

目的研究本院患者Rh表型的分布,并探讨Rh 5种抗原在临床匹配性输血应用的意义。方法实验组:我院患者和献血员进行ABO和Rh血型系统5种抗原(D、C、c、E、e)的血清学检测,并运用输血管理系统,建立Rh表型数据库,在ABO和RhD同型的基础上,对2016年1月—2017年12月27 929例患者进行RhC、c、E、e抗原匹配性输注;对照组:2014年1月—2015年12月23 105例未进行Rh抗原匹配的输血患者进行输血不良反应的发生率和不规则抗体分布进行比较。结果本院输血患者的Rh 5种抗原分析:D、C、e抗原比例分别为99.7%、94.5%、94%,C和e抗原比例接近D抗原,但分布明显高于c和E抗原;DCe和DCcEe表现型最多,两者占所有表型的70%以上,Dce和DCE两种表现型最为罕见,其他5种表现型分布尚可;Rh优先级匹配原则进行相容性输注,实验组中Rh 5种抗原完全匹配输注率达到84.7%,对照组中的输血不良反应的发生率明显高于实验组[0.39%(120/30 912)vs 0.28%(97/34 817);χ~2=5.97,P<0.05]差异具有统计学意义;在输血后新产生不规则抗体阳性患者中,实验组中Rh系统的抗体的产生率由之前的73.1%(对照组)下降至15.4%,实验组与对照组中患者新产生的不规则抗体阳性率相比具有明显差异[0.29%(67/23 105)vs 0.14%(39/27 929);χ~2=13.78,P<0.05]。结论对患者和献血者进行Rh 5种抗原检测,运用智能化输血管理系统建立一体化的Rh抗原数据库,对临床输血患者,特别是儿童、孕产妇、反复输血者,进行ABO和Rh 5种抗原全相合性输注,不仅能降低输血不良反应和避免Rh系统抗体的产生,而且是实现个性化和精准化输血的重要环节。

Objective To study the distribution of Rh phenotype in the Affiliated Hospital of Qingdao University and discusses the significance of 5 Rh antigens in the management of clinical transfusion.Methods The experimental group:5 ABO and Rh blood group system antigen(D,C,c,E,e)for serological tests were evaluated in both hospitalized patients and blood donors.A database of Rh phenotype was constructed using the transfusion management system.Based onn compatible ABO and RhD blood types,27 929 cases of patients with RhC,c,E,e antigen were received blood transfusion during January 2016 to December 2017.The Control group:The incidence of adverse reactions and irregular antibody distribution were compared with 23 105 patients who did not undergo Rh antigen matching between January 2014 to December 2015.Results The 5 antigen analysis of the population in the Affiliated Hospital of Qingdao University:the proportion of D,C and e antigen were respectively 99.7%,94.5%,94%,and C and e antigen were similar to D antigen.The distribution is significantly higher than that of C and e antigen.DCe and DCcEe were the dominate phenotypes,accounting for more than 70%of all phenotypes.DCe and DCe are the minority phenotypes,while the other five phenotypes were more widely distributed.Rh priority by transfusion of compatibility matching principle,the experimental group achieved a match transfusion rate of 84.7%.The incidence of adverse reactions of blood transfusion group were significantly improved than control group[0.39%(120/30 912)vs 0.28%(97/34 817);χ^2=5.97,P<0.05].The irregular antibody positive rate of the Rh system fell to 15.4%from 73.1%(control group)in the experimental group.The irregular antibody positive rate in the two groups showed significant difference[0.29%(67/23 105)vs 0.14%(39/27 929);χ^2=13.78,P<0.05].Irregular antibodies were negative before transfusion for the patients.Conclusion To test Rh five antigen of patients and blood donors,a Rh antigen database was constructed.For clinical blood transfusion patients,especially children,maternal and repeated transfusion patients,the combined transfusion strategy of ABO and Rh matching can not only reduce adverse blood transfusion reactions and avoid Rh antibody production,but also achieving certain levels of personalized and accurate blood transfusion treatment.