HLA-Ⅰ类基因及其抗体定量强度与配型血小板临床输注效果的相关性

Correlation between the quantitative intensity of HLA-Ⅰ gene and its antibody and the clinical transfusion effect of matching platelets

目的 探讨具有不同平均荧光强度(MFI)的抗-HLA-Ⅰ对HLA-A,-B基因配型血小板输注效果的影响,为临床血小板基因配型输注策略提供科学数据。方法 从81名临床血小板输注无效(PTR)、申请在本实验室血小板基因数据库中搜寻HLA-Ⅰ类基因配合型血小板的患者中,选择28名需要采用供者特异性抗体(DSA)部分规避策略患者(MFI<5 000),按输注患者抗-HLA-Ⅰ靶向抗原血小板MFI值分为阴性输注者(MFI<500)(A组)和阳性输注者(MFI≥500),后者进一步分为B组(500≤MFI<1 000)、C组(1 000≤MFI<3 000)、D组(MFI≥3 000);以校正血小板计数增加值(CCI)比较4组患者的血小板输注效果。结果 28名MFI<5 000的做血小板基因配型患者,有19例(67.86%)成功完成72次有效输注。A、B、C、D组首次CCI(×10~9/L)分别为10.27±7.46、7.58±4.75(P>0.05)、17.36±7.63(P>0.05)、-0.77±2.30(P<0.05)。结论 PTR患者采用HLA-Ⅰ基因配型血小板可以根据患者情况适当调整MFI阈值(<2 000)而不影响血小板输注效果。

Objective To explore the influence of anti-HLA-Ⅰ with different mean fluorescence intensity(MFI) on the efficacy of HLA-A and-B gene matching platelet transfusion, so as to provide scientific data for clinical platelet gene matching transfusion strategy. Methods A total of 81 PTR patients had applied for HLA-Ⅰgene matched platelets from the platelet gene database established by our laboratory, and 28(MFI <5 000) of them needed further avoiding of partial donor-specific antibodies and they were enrolled as the research subjects. According to the platelet MFI value of HLA-Ⅰ antibody-targeting antigen, they were divided into negative transfusion group(MFI <500)(group A) and positive transfusion groups(MFI≥500);the latter were further divided into group B(500≤MFI <1 000), group C(1 000≤MFI <3 000) and group D(MFI≥3 000) according to MFI value. Corrected count increment(CCI) in platelet count was used to compare the platelet transfusion effect in 4 groups. Results Among 28 platelet recipients with MFI <5 000, 19(67.86%) patients successfully received 72 effective transfusions. The first CCI(×10~9/L) in groups A, B, C and D were 10.27±7.46, 7.58±4.75(P>0.05), 17.36±7.63(P>0.05) and-0.77±2.30(P<0.05), respectively. There was no statistical difference among group A, B and C.Conclusion The application of HLA-Ⅰ gene matching platelets in PTR patients can adjust the MFI threshold(<2 000) appropriately according to the patient′s condition without compromising the platelet transfusion effect.