不规则抗体分布特征及临床意义

Distribution characteristics and clinical significance of irregular antibodies

目的分析不规则抗体分布特征及产生的相关因素,探讨其对临床输血的指导意义。方法回顾性分析拟接受输血治疗的11 150例住院患者的不规则抗体特异性,绘制不规则抗体分布图,并分析与不规则抗体产生相关因素。结果通过抗体筛选及抗体鉴定证实,11 150例临床拟输血患者共检出24例不规则抗体,阳性检出率为0.21%。在所检出的同种抗体中,RH血型系统的抗体最常见,占比为62.5%(其中抗-E 29.2%,抗-Ce 12.5%,抗-cE 12.5%,抗-C4.2%),其次为MNS血型系统,占比为20.8%(抗-M 12.5%,抗-N 4.2%,抗-Mia 4.2%);Lewis系统抗体(抗-Lea 2例)占比为8.3%;另发现抗-H抗体1例,抗-E合并抗-Jkb抗体1例。不规则抗体筛查阳性患者中有输血史、妊娠史者比例高于不规则抗体筛查阴性患者(P均<0.05)。在疾病类型分布上,不规则抗体筛查阳性患者与阴性患者比较差异亦有统计学意义(P <0.05),阳性患者中多见于妇产、血液和肾脏病患者。结论不规则抗体的产生主要以RH血型系统和MNS血型系统为主,及时、有效地进行不规则抗体筛选和鉴定对长期输血患者或孕产妇的输血安全至关重要。

Objective To analyze the distribution characteristics and related factors of irregular antibodies and investigate the guiding significance for clinical blood transfusion. Methods The specificity of irregular antibodies of 11 150 hospitalized patients scheduled to receive blood transfusion was retrospectively analyzed. The distribution map of irregular antibodies was drawn. The related factors of the production of irregular antibodies were analyzed. Results Antibody screening and identification confirmed that irregular antibodies were detected in 24 of 11 150 patients scheduled to receive clinical blood transfusion, with a positive detection rate of 0.21%. Among all irregular antibodies detected, the antibodies in the RH blood group system were the most common antibodies, accounting for 62.5%(29.2% of anti-E, 12.5% of anti-Ce, 12.5%of anti-cE, and 4.2% of anti-C), followed by the antibodies in the MNS blood group system, accounting for 20.8%(12.5% of anti-M, 4.2% of anti-N and 4.2% of anti-Mia), and the antibodies in the Lewis system(2 cases of anti-Lea) accounting for 8.3%, respectively. In addition, 1 case of anti-H antibody and 1 case of anti-E combined with anti-Jkb antibody were found. The proportion of patients who were positive for irregular antibodies with a history of blood transfusion or pregnancy was significantly higher than that of their negative counterparts(both P < 0.05). Regarding the distribution of disease types, statistical significance was observed between the positive and negative patients(P < 0.05). A majority of positive patients were diagnosed with obstetric, hematological and kidney diseases. Conclusions The irregular antibodies are mainly derived from the RH and MNS blood group systems. Timely and effective screening and identification of irregular antibodies are of significance for the safety of patients requiring long-term blood transfusion or pregnant women.