血小板输注无效患者HLA-Ⅰ类抗体产生率及其eplets的分析

Analysis of production rates of HLA-Ⅰantibodies and eplets in patients with platelet transfusion refractoriness

目的:筛选血小板输注无效(platelet transfusion refractoriness,PTR)的患者体内高免疫原性的人类白细胞抗原分子(human leukocyte antigen,HLA)-Ⅰ类抗体出现的频率并分析该基因型的eplets情况,以避免HLA-Ⅰ类抗体产生,提高血小板输注效果。方法:采用LUMINEX单抗原微珠包被法对133例PTR患者血清中可能存在的HLA-Ⅰ类抗体进行检测,利用HLA eplet网站(https://www.epregistry.com.br/)分析经抗体验证的eplets。结果:HLA-Ⅰ类抗体在PTR患者中的发生率为64.66%。其中,A*68:02、A*23:01、A*25:01、A*24:03、A*32:01、A*34:02、A*68:01等和B*57:01、B*15:12、B*49:01、B*08:01、B*15:16、B*56:01等基因型在人群中出现频率很低但抗体产生率较高。分析发现这些高免疫原性HLA分子大多含有一个或多个高免疫原性的eplets。结论:HLA-Ⅰ类的eplets个体间免疫原性相差较大,错配的eplets并不等价,血小板配型时应该避免这些高风险的eplets错配。

Objective:Screen frequencies of high immunogenic human leukocyte antigen(HLA)classⅠantibodies in patients with platelet transfusion refractoriness(PTR)and analyze the eplets of these genotypes to avoid the production of HLA-Ⅰantibodies and improve the effect of platelet transfusion.Methods:LUMINEX single antigen beads coating was used to detect possible HLA-Ⅰantibodies in the serum of 133 patients with PTR,and the HLA eplet website(https://www.epregistry.com.br/)was utilized to analyze eplets verified by antibodies.Results:The incidence of HLA-Ⅰantibodies in patients with PTR was 64.66%.Among them,A*68:02,A*23:01,A*25:01,A*24:03,A*32:01,A*34:02,A*68:01 etc.and B*57:01,B*15:12,B*49:01,B*08:01,B*15:16,B*56:01 etc.were infrequent in the population but therateofantibodyproductionwas high.The analysis found that most of these highly immunogenic HLA molecules contained one or more highly immunogenic eplets.Conclusion:The immunogenicity of HLA-Ⅰeplets varies greatly between individuals,and mismatched eplets are not equivalent.These high-risk eplet mismatchesshould be avoided during platelet matching.