血小板抗体产生的影响因素及临床输注效果的分析

The Analysis of Influence Factors on Platelet Antibody Production and Clinical Transfusion Effects

目的分析昆明医科大学第一附属医院937例患者的血小板抗体检测结果及其影响因素,探究血小板抗体对临床输注效果的影响,为血小板抗体检测的运用价值提供依据,确保血小板的输注更有效、更安全。方法2019年6月至2021年4月期间,从申请备血或输血的住院患者中随机收集937例患者的标本,并进行血小板抗体的检测,通过电子病历系统、LIS系统收集患者的一般临床资料。结果(1)多次输血患者血小板抗体阳性率为13.23%,血小板抗体的阳性率和输血的次数有关;(2)血小板抗体检测阳性率女性高于男性(15.95%VS.10.57%,P<0.05);(3)血小板抗体检测阳性率内科患者高于外科患者(16.31%VS.3.88%,P<0.05),其中内科中血小板抗体检测阳性率排前3的科室分别是血液科、急诊科、ICU(19.07%VS.18.42%VS.16.95%);(4)对于血液内科患者,化疗的次数、联合使用2类以上化疗药物、既往输注血小板的次数与血小板抗体的检出率显著相关(P<0.05);(5)血小板输注有效组与无效组的抗体阳性率在统计学上有差异(P<0.05);(6)血小板抗体中的HLA抗体在非溶血性发热反应中的检出率高达67.85%(19/28)。结论(1)血小板抗体的产生与输血次数呈正相关,影响血小板抗体阳性率的因素包括:血小板输注次数、女性孕产史、化疗病人化疗次数、化疗药物使用情况;(2)血小板抗体检测在血小板输注无效的调查研究,血液系统疾病及化疗患者输血疗效评估、输血策略制定、非溶血性发热性输血不良反应的诊断方面具有良好的运用价值;(3)配合性地输注血小板,能使血小板输注更有效。

Objective To analyze the platelet antibody detection results and the influence factors of 937 patients in our hospital,explore the impact of platelet antibodies on clinical transfusion effects,provide basis for the application value of platelet antibody detection,and ensure that platelet transfusion is more effective and safe.Methods From June 2019 to April 2021,samples from 937 patients were randomly collected from inpatients who applied for blood preparation or blood transfusion,and platelet antibodies were detected.The patients’general clinical data were collected through the electronic medical record system and LIS system.Results 1.The positive rate of platelet antibody in patients with multiple transfusions was 13.23%,and the positive rate of platelet antibody correlated with the number of transfusions with statistically significant differences;2.The positive rate of platelet antibody test was higher in women than in men(15.95%vs 10.57%,P<0.05);3.The positive rate of platelet antibody test was higher in medical patient than in surgical patient(16.31%vs 3.88%,P<0.05),among which the top three department of medicine with positive platelet antibody test rates were the hematology department,the emergency department,and ICU(19.07%vs 18.42%vs 16.95%);4.For patients in the hematology department,the number of chemotherapy,the combined use of more than 2 types of chemotherapy drugs,and the number of previous transfusion of platelets were significantly correlated with the detection rate of platelet antibodies(P<0.05);5.The positive rate of antibodies in the effective and ineffective groups of platelet transfusion was statistically different(P<0.05);6.The detection rate of HLA antibodies among platelet antibodies in non-hemolytic febrile reactions was as high as 67.85%(19/28).Conclusion 1.The production of platelet antibody is positively correlated with the number of blood transfusion,and the factors affecting the positive rate of platelet antibodies included:the number of platelet transfusions,female maternal history,the number of chemotherapy treatments in chemotherapy patients,and the use of chemotherapy drugs;2.The investigation and study of platelet antibody detection has the enormous application value in the ineffectiveness of platelet transfusion,the assessment of transfusion efficacy in patients with hematologic diseases and chemotherapy,the establishment of transfusion strategy,and the diagnosis of non-hemolytic febrile transfusion adverse reactions;3.The effect of Platelet transfusion can be significantly improved by coordinating platelets transfusion,and can effectively reduce the occurrence of ineffective platelets transfusion.