免疫性因素对常见血型意外抗体产生的影响探讨

An exploration on the effects of immune factors on the production of unexpected antibodies of common blood types

目的探讨免疫性因素对常见血型意外抗体产生的影响。方法回顾性分析2013年3月至2022年2月上海市血液中心血型参比实验室检出的明确记录患者输血史和妊娠史的意外抗体案例。排除直抗阳性、自身抗体、药物抗体、冷自身抗体及新生儿患者,排除混合抗体,最终共有1920例入组。统计产生抗体患者的输血史和妊娠史,将其分为有输血史及妊娠史组(A组,331例)、仅有输血史组(B组,231例)、仅有妊娠史组(C组,1068例)、无输血无妊娠史组(D组,290例)。其中有输血史者分为多次输血组326例和单次输血组236例。分析免疫性因素对常见血型意外抗体产生的影响。结果B组与C组数据在分布趋势上存在明显的不一致性。B组抗E、抗Ec、抗Ce抗体检出率高于D组,抗M、抗Lea抗体检出率低于D组,差异有统计学意义(P<0.05)。C组抗D、抗E抗体检出率高于D组,抗M、抗Leb抗体检出率低于D组,差异均有统计学意义(P<0.05)。多次输血组抗Ce、抗Kidd、抗Ec抗体检出率高于单次输血组,抗DC、抗D抗体检出率低于单次输血组,差异有统计学意义(P<0.05)。不同特异性意外抗体在A组与B组分布差异无统计学意义(χ^(2)=15.400,P=0.350),而与C组比较差异有统计学意义(P<0.05)。结论不同特异性抗体在输血患者、经产妇、无明显免疫史个体中的分布有显著差异。妊娠对血型意外抗体的产生也有显著影响,而对于意外抗体检测及输血安全而言,既往输血史的免疫学意义远大于妊娠史。研究血型意外抗体产生、分布及变化的规律,有助于安全输血,以及疾病的诊断和治疗。

Objective To explore the effects of immune factors on the production of unexpected antibodies of common blood types.Methods The unexpected antibody cases with clearly recorded transfusion and pregnancy history detected in the Blood Group Reference Laboratory of Shanghai Blood Center from March 2013 to February 2022 were retrospectively analyzed.The direct antiglobulin test(DAT)positive,autoantibodies,drug antibodies,cold autoantibodies and neonatal patients,and mixed antibodies were excluded.A total of 1920 cases were finally enrolled.The blood transfusion history and pregnancy history of the patients who produced antibodies were counted,and they were divided into blood transfusion and pregnancy history group(group A,331 cases),blood transfusion history group(group B,231 cases),pregnancy history group(group C,1068 cases),non-blood transfusion and non-pregnancy history group(group D,290cases).The patients with blood transfusion history were divided into multiple blood transfusion group(326 cases)and single blood transfusion group(236 cases).The effects of immune factors on the production of unexpected antibodies of common blood types were analyzed.Results There was no obvious consistency in the distribution trend between the group B and the group C.The detection rates of anti-E,anti-Ec and anti-Ce antibodies in the group B were higher than those in the group D,and the detection rates of anti-M and anti-Lea in the group B were lower than those in the group D,and the differences were statistically significant(P<0.05).The detection rates of anti-D and anti-E in the group C were higher than those in the group D,but the detection rates of anti-M and anti-Leb in the group C were lower than those in the group D,and the differences were significantly different(P<0.05).The detection rates of anti-Ce,anti-Kidd and anti-Ec in the multiple blood transfusion group were higher than those in the single blood transfusion group.The detection rates of anti-DC and anti-D in the multiple blood transfusion group were lower than those in the sigle blood transfusion group,and the differences were statistically significant(P<0.05).There were no statistically significant differences between the group A and the group B in the distributions of different specific unexpected antibodies(χ^(2)=15.400,P=0.350),but there was a statistically significant difference between the group A and the group C(P<0.05).Conclusion There are significant differences in the distributions of different specific antibodies in blood transfusion patients,multiparae and individuals without obvious immune history.Pregnancy also has a significant impact on the production of unexpected antibodies of blood types,and for the detection of unexpected antibodies and the safety of blood transfusion,the significance of previous blood transfusion history is much greater than that of pregnancy history.The study on the laws of production,distribution and variation of unexpected antibodies of blood types will bring valuable help to the safety of blood transfusion and even the diagnosis and treatment of diseases.