血小板配型输注在不同血液疾病患者中的效果分析

Analysis of effect of platelet matching on platelet transfusion in patients with hematological diseases

目的:评估血小板配型输注对血液病患者的临床疗效,比较3种不同血液疾病(再生障碍性贫血、骨髓增生异常综合征及白血病)患者血小板配型输注的效果差异。方法:回顾性研究我院尚未开展血小板配型(2017年随机ABO同型输注)3种血液疾病患者及全面开展血小板配型(2018年ABO同型且血小板配型输注)血液疾病患者的临床资料。采用固相凝集法进行血小板配型,以24 h血小板增加指数值(CCI)评估血小板输注效果。结果:2017年血液病患者人均血小板用量(血小板用量/出院人次)为9.2 U(36370/3953),2018年血液病患者人均血小板用量为8.8 U(38960/4403),血小板人均用量下降4.3%。2017年3种血液疾病患者共182例,输注血小板1232次,平均CCI为8.6±8.3,输注有效率为48%(591/1232);2018年3种血液疾病患者共203例,输注血小板1427次,平均CCI为15.7±10.7,输注有效率为80%(1145/1427),2018年CCI及输注有效率均显著上升(P<0.05)。2017年再生障碍性贫血患者CCI为6.3±5.9,输注有效率为47%(80/170),再次输注血小板间隔时间为(2.6±1.7)d,2018年CCI则为18.3±14.2,输注有效率为79%(68/95),再次输注血小板间隔时间为(6.5±6.3)d,输注有效率显著提高且间隔时间明显延长(P<0.05);2017年骨髓增生异常综合征患者CCI为7.2±6.6,输注有效率为51%(75/147),再次输注血小板间隔时间为(5.4±4.8)d,2018年CCI则为13.4±13.0,输注有效率为79%(304/385),再次输注血小板间隔时间为(6.4±5.0)d,输注有效率显著提高(P<0.05),间隔时间少量延长,但差异无统计学意义;2017年白血病患者CCI为8.3±7.7,输注有效率为48%(436/915),再次输注血小板间隔时间为(5.8±5.3)d,2018年CCI则为15.6±10.5,输注有效率为82%(773/947),再次输注血小板间隔时间为(6.3±5.9)d,输注有效率显著提高(P<0.05),间隔时间少量延长,但差异无统计学意义。结论:输注配型血小板可明显提升不同血液疾病患者的血小板输注有效率,且明显缩短再生障碍性贫血患者输注血小板间隔时间,促进血小板资源保护。

Objective:To evaluate the clinical efficacy of platelet matching in patients with hematologic diseases and compare the effect of platelet matching in patients with three different hematologic diseases including of aplastic anemia,myelodysplastic syndrome and leukemia.Method:The clinical data of three kinds of blood disease patients without platelet matching(2017)and those who with platelet matching(2018)were retrospectively studied.Platelet matching was performed by solid-phase agglutination,and platelet transfusion was evaluated by corrected count of increment(CCI)in 24 hours.Result:In 2017,the per capita platelet consumption(platelet consumption/discharge person time)was 9.2 U(36370/3953),while this in 2018 was 8.8 U(38960/4403),the per capita platelet consumption decreased by 4.3%.In 2017,182 patients with three kinds of blood diseases received 1232 platelet transfusions,with an average CCI of 8.6±8.3 and an effective rate of 48%(591/1232);in 2018,203 patients with three kinds of blood diseases received 1427 platelet transfusions,with an average CCI of 15.7±10.7 and an effective rate of 80%(1145/1427).In 2018,both CCI and the effective rate of transfusion increased significantly(P<0.05).In 2017,the CCI of aplastic anemia patients was 6.3±9.9,the effective rate of transfusion was 47%(80/170),the interval time of platelet transfusion was(2.6±1.7)days,in 2018,the CCI was 18.3±14.2,the effective rate of transfusion was 79%(68/95),the interval time of platelet transfusion was(6.5±6.3)days,the effective rate of transfusion was significantly improved and the interval time was significantly prolonged(P<0.05);in 2017,the CCI of myelodysplastic syndromes patients was 7.2±6.6,the effective rate of transfusion was 51%(75/147),the interval time of reinfusion of platelets was(5.4±4.8)days,the CCI in 2018 was 13.4±13.0,the effective rate of transfusion was 79%(304/385),the interval time of reinfusion of platelets was(6.4±5.0)days,the effective rate of transfusion was significantly improved(P<0.05),and the interval time was slightly prolonged but not statistically significant.In 2017,the CCI of leukemia patients was 8.3±7.7,the effective rate of transfusion was 48%(436/915),the interval time of reinfusion of platelets was(5.8±5.3)days,in 2018,the CCI was 15.6±10.5,the effective rate of transfusion was 82%(773/947),the interval time of reinfusion of platelets was(6.3±5.9)days,the effective rate of transfusion was significantly improved(P<0.05),and the interval time was slightly prolonged but not statistically significant significance.Conclusion:Platelet matching could significantly improve the efficiency of platelet transfusion in the patients with different hematologic diseases,shorten the interval time of platelet transfusion in the patients with aplastic anemia,and promote the protection of platelet resources.