肝硬化患者ABO和Rh(D)同型随机配合性输血Rh(CcEe)同种免疫及影响因素分析

Analyze the Influencing Factors and Alloimmunization on Rh(CcEe)in Patients with Liver Cirrhosis after ABO,Rh(D)Isotype Random Matched Blood Transfusion

目的分析肝硬化患者ABO和Rh(D)同型随机配合性输血Rh(CcEe)同种免疫及影响因素。方法纳入病例为2019年1月1日~2021年6月30日本院肝胆病区拟输血治疗的肝硬化患者301例,男性206例,女性95例,排除临床资料不完整和首次入院已检出Rh(CcEe)同种抗体者。采用单因素、多因素Logistic回归分析肝硬化患者ABO和Rh(D)同型随机配合性输血Rh(CcEe)同种免疫影响因素。结果(1)301例患者Rh(CcEe)同种抗体检出率为6.6%(20/301例),其中抗-E占70.0%(14/20例),抗-Ec复合抗体占5.0%(1/20例),抗-Ec混合抗体占10.0%(2/20例),抗-C抗占10.0%(2/20例),抗-Ce复合抗体占5.0%(1/20例)。(2)不同病因、不同输注异体红细胞成分血次数、不同血型间肝硬化患者ABO和Rh(D)同型随机配合性输血Rh(CcEe)同种免疫情况存在统计学差异(P<0.05)。(3)单因素Logistic回归分析显示自身免疫性肝炎后肝硬化、输注异体红细胞成分血次数5~9次、输注异体红细胞成分血次数≥10次和O型是肝硬化患者ABO和Rh(D)同型随机配合性输血发生RhCcEe同种免疫的危险因素,OR值分别是6.888(95%CI:2.022~23.461)、14.444(95%CI:2.980~70.024)、30.469(95%CI:6.380~145.508)、12.444(95%CI:1.597~97.001)。(4)多因素Logistic回归分析显示自身免疫性肝炎后肝硬化、输注异体红细胞成分血次数5~9次、输注异体红细胞成分血次数≥10次和O型是肝硬化患者ABO和Rh(D)同型随机配合性输血发生Rh(CcEe)同种免疫的危险因素,OR值分别是16.909(95%CI:2.402-119.021)、22.311(95%CI:3.496~142.387)、36.527(95%CI:5.758~231.718)、10.160(95%CI:1.061~97.281)。结论肝硬化患者ABO和Rh(D)同型随机配合性输血后Rh(CcEe)同种抗体发生风险较高,自身免疫性肝炎后肝硬化、O型、输注异体红细胞成分血次数是肝硬化患者ABO和Rh(D)同型随机配合性输血发生Rh(CcEe)同种免疫的危险因素,尤其输注异体红细胞成分血次数5~9次和≥10次者更显著。建议对肝硬化患者采取ABO,RhD(DCcEe)同型输血。

Objective Analyze the influencing factors on Rh(CcEe)alloimmunization in patients with liver cirrhosis after ABO,Rh(D)isotype random matched blood transfusion.Method A total of 301 liver cirrhosis patients who received blood transfusion in the hepatobiliary regions of our hospital from January 1,2019 to June 30,2021 were included,including 206 males and 95 females.Patients with incomplete clinical data and Rh(CcEe)alloantibody detected in the first admission were excluded.Univariate and multivariate Logistic regression were carried out to analyze the influencing factors on Rh(CcEe)alloimmunization in patients with liver cirrhosis after ABO,Rh(D)isotype random matched blood transfusion.Result(1)Within the 301 patients,the positive rate of Rh(CcEe)alloantibody was 6.6%(20/301).The percentage of anti-E antibody,anti-Ec composite antibody,anti-Ec mixed antibody,anti-C antibody,antiCe composite antibody were 70.0%(14/20),5.0%(1/20),10.0%(2/20),10.0%(2/20),5.0%(1/20),respectively.(2)There were statistical differences in the alloimmunization of Rh(CcEe)in patients with liver cirrhosis after ABO,Rh(D)isotype random matched blood transfusion with different causes,different red blood cell transfusion times and different blood types(P<0.05).(3)Univariate Logistic regression analysis showed that liver cirrhosis after autoimmune hepatitis,red blood cell transfusion 5~9 times,red blood cell transfusion times more than or equal to 10 and type O blood were the risk factors of the Rh(CcEe)alloimmunization in patients with liver cirrhosis.The OR values were 6.888(95%CI:2.022~23.461)、14.444(95%CI:2.980~70.024)、30.469(95%CI:6.380~145.508)、12.444(95%CI:1.597~97.001)respectively.(4)Multivariate Logistic regression analysis indicated that liver cirrhosis after autoimmune hepatitis,red blood cell transfusion 5~9 times,red blood cell transfusion times greater than or equal to 10 and type O blood were the risk factors of the Rh(CcEe)alloimmunization in patients with liver cirrhosis.The OR values were16.909(95%CI:2.402~119.021)、22.311(95%CI:3.496~142.387)、36.527(95%CI:5.758~231.718)、10.160(95%CI:1.061~97.281)respectively.Conclusion The risk of Rh(CcEe)alloantibody is higher in patients with liver cirrhosis after ABO,Rh(D)isotype random matched blood transfusion.Liver cirrhosis after autoimmune hepatitis,red blood cell transfusion times,and type O blood were the risk factors of the Rh(CcEe)alloimmunization in patients with liver cirrhosis,especially those with 5~9 times of blood transfusion and greater than or equal to 10 times of red blood cell transfusion.It is recommended to adopt ABO,Rh(DCcEe)isotype blood transfusion for patients with liver cirrhosis.