TRALI相关致病因子在输血患者中的表达分析

Analysis of TRALI related pathogenic factors expression in patients with blood transfusion

目的:观察多次输血患者、输血相关性急性肺损伤(TRALI)疑似患者和健康献血者3个队列的TRALI相关致病因子,探讨TRALI的发病机制。方法:选取54例输血患者(多次输血患者27例,TRALI疑似患者27例)的外周血标本,另选36例正常献血者的外周血作为对照。用流式细胞仪检测多形核中性粒细胞(PMN)表面CD11a与CD11b抗原的分布与表达,用ELISA法检测外周血细胞间黏附分子-1(ICAM-1)蛋白含量。结果:与TRALI疑似患者、多次输血患者相比,献血者(97.50%±1.68%)PMN含CD11a和CD11b抗原的阳性率均显著高于TRALI疑似患者(79.37%±18.57%)和多次输血患者(87.93%±8.91%),差异有统计学意义(P=0.0036,P=0.0022)。与献血者(64.39±21.08 ng/mL)比较,TRALI疑似患者血浆中ICAM-1蛋白含量(99.69±28.10 ng/mL)相对较高,差异有统计学意义(P=0.0024);而多次输血患者(85.41±35.54 ng/mL)与献血者比较,差异无统计学意义(P>0.05)。结论:本研究发现献血者人群PMN细胞的CD11b激活状态比例较高,而多次输血患者和TRALI疑似患者的PMN细胞可能由于炎症因子等因素干扰逐渐丧失CD11a和CD11b抗原活性。此外,PMN的致敏黏附聚集和ICAM-l参与的炎症反应有关。

Objective:To investigate the pathogenesis of transfused acute lung injury(TRALI)by observing the TRALI-related pathogenic factors in three groups among patients with multiple blood transfusions,TRALI suspect patients and healthy blood donors.Methods:The distribution and expression of CD11 a and CD11 b antigens on PMN were detected by flow cytometry.The content of ICAM-1 protein in plasma was determined by ELISA.Results:The positive rates of CD11 a and CD11 b antigens in PMN of blood donors(97.50%±1.68%)were significantly higher(P=0.0036,P=0.0022)than those of TRALI suspect patients(79.37%±18.57%)and multiple transfusions patients(87.93%±8.91%).Compared with the blood donors(64.39±21.08 ng/mL),the ICAM-1 protein content of the TRALI suspect patients(99.69±28.10 ng/mL)was relatively high(P=0.0024).However,there was no significant difference between multiple transfusion patients((85.41±35.54 ng/mL))and blood donors(P>0.05).Conclusion:In this study,CD11 b activation rate of PMN cells in blood donors was higher,while PMN cells in multiple transfusions patients and TRALI suspected patients may gradually lose their CD11 a and CD11 b antigens due to inflammatory factors.In addition,the sensitized,adhesion and aggregation of PMN may be related to the inflammatory reaction involving ICAM-1.