机采血小板献血者外周血血小板计数水平影响因素的纵向研究

Longitudinal Study of Influencing Factors on Peripheral Platelet Count of Plateletpheresis Donor

目的探讨《献血者健康检查要求(GB18467-2011)》调整机采血小板献血者献血间隔期对献血者外周血小板计数水平的影响.方法应用R3.5.1统计软件,选取纵向数据分析方法中的线性混合效应模型,跟踪探访2016年1月1日~2018年9月30日期间捐献血小板总次数超过10次的机采血小板献血者,选取23次献血以内的外周血血小板观测值及可能的混杂因素进行建模分析;建立允许协变量截距随机变化的线性混合效应模型一和允许协变量截距和协变量献血间隔期斜率随机变化线性混合效应模型二.结果AIC、BIC及似然值差值的分布均显示模型二优越于模型一.模型二中,协变量截距、外周血小板计数基线值、献血间隔期、采集量、年龄、性别、献血次数及献血间隔期和献血次数交互效应的参数估计值分别为59.708、0.795、–0.023、3.798、–0.234、7.173、0.385及–0.004,均具有统计学意义.结论现行的最短间隔期对于献血次数较少的献血者,不会造成外周血小板计数水平较大的波动,长期以较短间隔期献血,可能对外周血小板计数水平带来一定的波动,但波动量级仍然较小;对于多次献血者,若持续以较短间隔期采集,应每次采集较少治疗单位或者延长间隔期,待人体自我调整至稳定区间后再继续献血,以减少外周血小板计数水平的波动.

Objective To explore the effect of the blood donation interval adjustment of plateletpheresis donor released by Whole Blood and Component Donor Selection Requirements(GB1 8 4 6 7-2 0 1 1)on the peripheral platelet count level.Methods The linear mixed effect model in the longitudinal data analysis method was selected to model the plateletpheresis donors who donated plateletpheresis more than 10 times from September 30,2016 to September 30,2018,using R 3.5.1 statistical software.Periphery platelet count level and possible confounding factors within 23 plateletpheresis donations were selected for modeling analysis.Mixed effect model with a random intercept(model1)and with both a random intercept and a random slope for interval(model2)was established.Results AIC,BIC and the significance of distributions of the log(restricted)likelihood difference showed that model 2 was superior to model 1.In model 2,the parameter estimates of covariate intercept,periphery platelet baseline count,blood donation interval,collection volume,age,gender,blood donation times and the interaction effect of blood donation interval and blood donation times were 5 9.7 0 8,0.7 9 5,–0.0 2 3,3.7 9 8,–0.234,7.173,0.385 and–0.004,respectively.All of the above parameters were of statistical significance.Conclusion The current minimum interval rule does not cause a large fluctuation of periphery platelet count for plateletpheresis donors with a few blood donations.Long-term blood donation in a shorter interval may cause a certain fluctuation in periphery platelet count,but the fluctuation magnitude is still small.For frequently repeated blood donors with short intervals,less platelet volume or extended interval properly should be considered to reduce the fluctuation of periphery platelet count.