循环免疫复合物对血液病患者血小板输注疗效的影响

Effect of circulating immune complex on the efficacy of platelet transfusion

目的分析血液病患者预防性血小板ABO同型输注及非同型输注的疗效,探讨循环免疫复合物(CIC)对血小板ABO同型及非同型血小板输注疗效的影响。方法选取2013年1月~2018年6月在本院血液科行血小板输注的757例患者,共输注机采血小板1510例次,分为ABO同型组和ABO非同型组。利用12 h血小板恢复率来(PPR)评估各组间的血小板输注疗效。体外模拟患者输注ABO同型及非同型血小板,用血栓弹力图(TEG)评估其输注疗效,并测量体外模拟患者输注血小板前后CIC含量的变化。测试A-B/CIC和AB-O/CIC对血小板功能的影响。结果1)血液病患者ABO同型组[PPR=(66.5±52.8)%]与非同型组[PPR=(47.7%±51.6)%]的血小板输注均有效(PPR>30%),且临床上ABO非同型组受血者溶血性输血反应报告并未增多;同型血小板输注组的疗效明显好于非同型组(P<0.05);如果1个患者曾多次输注非同型血小板,再次输注同型血小板的疗效[PPR=(49.8%±51.8)%]与输注非同型血小板的疗效[PPR=(47.7%±51.6)%]无差异(P>0.05)。2)体外模拟患者血小板输注实验中,各不同型组MA值与同型组比均无差异(P>0.05)。3)在体外模拟患者输注血小板后CIC含量的变化的实验中,同型组CIC值与输注前无差异(P>0.05),各不同型组CIC值较输注前减少(P<0.05)。4)AB、A、O型的机采血小板分别与A-B/CIC混合后的MA值分别为36.1 mm、37.8 mm、43.1 mm(对照MA值为49.2 mm);AB、A、O型的机采血小板分别与AB-O/CIC混合后的MA值分别为31.1 mm、35.0 mm、45.7 mm(对照MA值为49.5 mm)。结论输注ABO同型及非同型血小板都可以达到血小板输注有效的标准,同型组疗效好于非同型组。主侧不合次侧相合组输注安全风险无增加。CIC能抑制血小板功能,并且CIC与ABO非同型血小板结合多于同型血小板,CIC是影响血小板输注疗效的一个重要因素。

Objective To analyze the efficacy of ABO-matched platelet transfusions and ABO-mismatched platelet transfusions in patients with hematonosis and to explore the effect of circulating immune complexes(CIC)on the efficacy.Methods A total of 1510 platelet transfusions involving 757 patients in our hospital from January 2013 to June 2018 were retrospectively analyzed.The patients were divided into ABO-matched group and ABO-mismatched group.The 12-hour percent platelet recovery(PPR)was used to evaluate the effect of platelet transfusion between the groups.TEG was used to evaluate the efficacy of the transfusions,and CIC value was measured before and after platelet transfusion.The effect of A-B/CIC(or AB-O/CIC)on platelet function was tested.Results 1)The results showed that platelet transfusion was effective(PPR>30%)in both ABO-matched group[PPR=(66.5±52.8)%]and ABO-mismatched group[PPR=(47.7%±51.6)%],and there was no increase in the report of hemolytic transfusion reaction of ABO-mismatched group.The efficacy of ABO-matched platelet transfusions was significantly better than that of ABO-mismatched group(P<0.01).If a patient had received multiple transfusions of ABO-mismatched platelet,there were no significance between ABO-matched group[PPR=(49.8%±51.8)%]and ABO-mismatched group[PPR=(47.7%±51.6)%],P>0.05.2)In the experiment of simulating platelet transfusion in patients,no difference in MA value of TEG was noticed between ABO-mismatched groups and ABO-matched groups(all P>0.05).3)There was no difference in CIC value before and after platelet transfusions(P>0.05)in the ABO-matched group,while CIC value decreased significantly in all ABO-mismatched groups(all P<0.05).4)The MA values(mm)of AB,A and O blood group platelets mixed with A-B/CIC and AB-O/CIC were 36.1 vs 31.1,37.8 vs 35.0 and 43.1 vs 45.7,with the MA value(mm)in control group at 49.2 vs 49.5,respectively.Conclusion Platelet transfusion was effective in both ABO-matched group and ABO-mismatched group,and the efficacy of ABO-matched group was significantly better compared with the ABO-mismatched group.There was no increase in the safety risk of ABO-mismatched platelet transfusion with major mismatches/minor matches.CIC can inhibit the function of platelets and combine more with ABO-matched platelets than with ABO-mismatched platelets,therefore,CCI is an important influencing factor on the efficacy of platelet transfusions.