40例自身免疫性溶血性贫血患者输血和激素治疗的疗效及安全性评估

Evaluation of Efficacy and Safety of Blood Transfusion and Hormone Therapy in 40 Patients with Autoimmune Hemolytic Anemia

目的:评估不同种类红细胞输注和激素治疗对自身免疫性溶血性贫血(AIHA)患者的疗效及安全性。方法:收集并回顾性分析2014-2018年本院收治的40例AIHA患者的临床资料和血清学特征,按照交叉配血后接受最小不相合红细胞输注的原则,评估不同种类红细胞、激素疗效及其安全性。结果:40例AIHA患者中,女性多于男性,继发性多于原发性,温自身抗体占绝大多数。11例AIHA患者进行了26次最小不相合红细胞输注,总有效率46.2%,部分有效率23.1%,无效率30.8%;其中,同型非洗涤红细胞组有效率42.1%,部分有效率21.1%,无效率36.8%;同型洗涤红细胞组有效率57.1%,部分有效率28.6%,无效率14.3%;2组输注疗效无显著性差异且均无溶血性输血反应发生。激素治疗组AIHA患者完全缓解15.2%,部分缓解63.6%,无效21.2%;其中,2例患者使用激素后产生副作用。结论:AIHA患者输血时,采用同型非洗涤红细胞或同型洗涤细胞输注都相对安全,疗效差异无显著性;激素治疗的部分缓解率远高于红细胞输注,但容易产生副作用。

Objective:To evaluate the efficacy and safety of different types of red blood cell(RBC)transfusion and hormone therapy in patients with autoimmune hemolytic anemia(AIHA).Methods:The clinical data and serological characteristics of 40 patients with AIHA treated in our hospital from 2014 to 2018 were collected and analyzed retrospectively.The efficacy and safety of different type of RBC transfusion and hormone therapy were evaluated according to the principle of minimally incompatible RBC transfusion after cross-matching.Results:Among 40 patients with AIHA,the female cases were more than the male cases,the cases of secondary AIHA was more than cases of primary AIHA,and the warm autoantibodies were in the majority.11 cases of AIHA underwent 26 times minimally incompatible red blood cell transfusions.The total effective rate was 46.2%,the partial efficiency was 23.1%,and total inefficiency was 30.8%.Among them,the same type of non-washing red blood cell group showed efficiency of 42.1%,partial effective rate of 21.1%,and inefficiency of 36.8%;the same type of washed red blood cell group showed efficiency of 57.1%,partial effective rate of 28.6%,and inefficiency of 14.3%.the infusion effects was not significanly different between the two groups,and no hemolytic transfusion reaction occurred.In the hormone-treated group,the complete remission rate was 15.2%,the partial remission rate was 63.6%,and the ineffective rate was 21.2%.Among them,the side effects appeared in 2 patients after using hormones.Conclusion:When AIHA patients need blood transfusion,use the same type of non-washed red blood cells or homologous washed cells is relatively safe,and the difference in efficacy is not significant.The partial remission of patients received hormone therapy is much higher than that of red blood cell transfusion,but the side effects easily happen.