Rh E抗原双群原因分析及其输血后对机体免疫功能的影响

Reason analysis of RhE antigen double group and its effect on immune function after blood transfusion

目的分析E抗原在血型鉴定中出现双群的原因及其输血后对机体免疫功能的影响。方法收集河南省人民医院2014年1月至2017年12月25069例血型鉴定结果,其中RhE抗原双群者2405例,分析E抗原出现双群的原因。选择100例RhE抗原阴性者为A组,另100例RhE抗原双群者为B组,两组接受的供血者均为RhE抗原阳性,追踪两组输血后输血反应的发生率。利用流式细胞术比较两组输血前和输血后5、10dCD4^+、CD8^+细胞的变化。结果RhE抗原阳性者与RhE抗原阴性者比例基本相当,RhE抗原双群者占9.5%;输血史是RhE抗原出现双群的主要原因;B组发生输血不良反应的相对风险高于A组;A、B组输血后5d均出现CD4^+T细胞增高,CD8^+T细胞降低,但A组输血后10dCD4^+和CD8^+细胞逐渐恢复正常,B组输血后10d与输血后5d比较,差异未见统计学意义(P<0.05);B组输血后5、10dCD4^+细胞数均高于A组,B组CD8^+细胞低于A组(P均<0.05)。结论RhE抗原双群者在输血中应尽可能输注RhE抗原阴性血,以保证输血安全。

Objective To analyze the cause of RhE antigen double group and investigate the effect on immune function in patients with blood transfusion. Methods The results of blood group identification were collected from 25 069 cases in Henan Provincial People’s Hospital from January 2014 to December 2017. Among them, 2 405 cases were Rh E antigen double group, and the causes of double groups of E antigen were analyzed. Among them. 100 Rh E antigen negative patients were set as group A, and 100 RhE antigen double group patients as group B. The blood donors in both groups were RhE-positive. The incidence of transfusion reaction after blood transfusion in the two groups was tracked. Flow cytometry was used to compare the changes of CD4^+ and CD8^+ cells before and after transfusion in two the groups. Results The proportion of Rh E antigen positive and Rh E antigen negative was almost the same, Rh E antigen double group accounted for 9.5%. The history of blood transfusion was the main reason of double groups of RhE antigen. The relative risk of adverse transfusion reaction in group B was higher than that in group A;CD4+ T cells increased and CD8+ T cells decreased in group A and group B 5 days after transfusion, but CD4^+ and CD8^+ cells gradually returned to the normal level 10 days after transfusion in group A, and there was no significant difference between 10 days after transfusion and 5 days after transfusion in group B. The number of CD4^+ cells in group B was higher than that in group A 5 and 10 days after transfusion, and the number of CD8^+ cells was lower than that in group A (all P<0.05). Conclusions Patients with Rh E antigen double group should be infused with RhE antigen negative blood as far as possible in transfusion strategy to ensure the safety of blood transfusion.