HLA抗原选择性和常规交叉配型血小板输注效果比较

Application of HLA-matched or routine cross-matched platelets for patients refractory to platelet transfusion, a comparative study

目的回顾性评估HLA抗原选择性与常规交叉配型对于血小板输注无效患者的输注效果。方法选择2019年1月—2020年6月,于重庆市血液中心行血小板配型的病例,其中57名血小板抗筛阳性的患者作为研究对象。血小板抗体检测采用固相红细胞黏附法和酶联免疫吸附试验,对比HLA抗原选择性和常规交叉配型血小板的输注有效率及血小板增高指数(CCI)。并对供、受者进行HLA-A、-B位点匹配度分析。结果 57例抗筛阳性的血小板输注无效患者中,其中单一HLAⅠ类抗体阳性48例(84.2%),单一HPA抗体阳性1例(1.8%),HLAⅠ类+HPA抗体7例(12.3%),1例非特异性抗体。57名患者共输注188例配型血小板,其中22例为HLA选择性输注,平均CCI值10.2[四分位间距(IQR) 3.6,17.5],166例为常规交叉配型输注,平均CCI值4.8(IQR:1.4,11.6),两者具有统计学差异(P<0.05)。按照HLA抗原匹配度分级,分析输注效果:A、B、C、D级输注有效率分别为71.4%、66.7%、50.0%、40.7%,A和B级输注后平均CCI值10.2(IQR:4.4,16.0),C和D级输注后平均CCI值4.1(IQR:0,14.8),具有统计学差异(P<0.05)。结论 HLAⅠ类抗体仍然是引起血小板无效输注的主要免疫原因。HLA抗原选择性输注在提高患者血小板计数方面明显优于常规交叉配型,选择与患者HLA抗原匹配度达到A或B级供者血小板能够得到较好的输注效果。

Objective To retrospectively evaluate the efficacy of HLA-matching and routine cross-matching in patients refractory to platelet transfusion. Methods From January 2019 to June 2020, 57 cases with positive platelet antibodies were selected out of routine cross-matching patients in Chongqing Blood Center as research subjects. Platelet antibodies were detected by solid phase red cell adherence and enzyme-linked immunosorbent assay. The effective rate and platelet corrected count increment(CCI) of HLA-matching and cross-matching platelet transfusion were compared. The matching grade of HLA-A and-B loci for the platelet donors and recipients were also analyzed. Results Among the 57 patients with positive platelet antibodies, refractory to platelet transfusion, anti-HLA class Ⅰ antibodies positive were found in 48(84.2%), anti-HPA antibodies positive in 1(1.8%), both anti-HLA class Ⅰ and anti-HPA antibodies positive in 7(12.3), and non-specific antibody in 1.57 patients received a total of 188 matched platelets. Of these, 22 patients received HLA-matched platelets, with median CCI of 10.2 [interquartile range(IQR), 3.6,17.5], and 166 patients received cross-matched platelets [mean CCI, 4.8;IQR, 1.4,11.6];there were significant difference when comparing HLA-matched and cross-matched platelets with each other(P<0.05). According to HLA matching grade classified as A, B, C and D, the effective incidence of platelet transfusion at grade A, B, C and D was 71.4%, 66.7%, 50.0% and 40.7%, respectively. The median CCI of grade A and B was 10.2(IQR, 4.4, 16.0), and that of grade C and D was 4.1(IQR, 0,14.8), showing statistical difference in comparison to each other(P<0.05). Conclusion HLA Class Ⅰ antibodies remain the main immune cause for platelet transfusion refractoriness. The HLA-matched platelet transfusion incurs better outcome than the routine cross-matched one in improving the patients′ platelet count. Donor selection with HLA matching grade at A or B may provide even better increments in platelet count.