血液病患者产生抗HLA抗体的危险因素分析

Analyse the risk factors for producing anti-HLA antibodies in patients with hematological diseases

目的在造血干细胞移植前的血液病患者中,探究抗人类白细胞抗原(human leucocyte antigen,HLA)抗体产生的危险因素。方法收集2016-2018年间本院1008名血液病患者在移植前采用Luminex技术平台进行抗HLA抗体检测的结果及临床数据,并对其进行统计学分析。结果1008名患者的抗HLA抗体总体阳性率为24.08%。多因素分析显示,与抗HLA抗体产生相关的独立危险因素包括年龄≥30岁(P=0.046,OR 1.467,95%CI 1.007-2.136)、疾病确诊至抗体检测的时间≥41d(P=0.000,OR 1.830,95%CI 1.306-2.565)、初诊PLT计数<20×109/L(P=0.020,OR 1.543,95%CI 1.072-2.220)、有妊娠史(P=0.000,OR 5.187,95%CI 3.689-7.293)、入院前有输血史(P=0.001,OR 1.762,95%CI 1.257-2.470)和入院后PLT输注总量≥30U(P=0.000,OR 2.352,95%CI 1.638-3.376)。其中年龄≥30岁(P=0.023,OR=1.839,95%CI 1.088-3.108)、妊娠史(P=0.042,OR=5.258,95%CI 1.062-26.038)分别与抗HLA-Ⅰ类、Ⅱ类抗体的产生有关;疾病确诊至抗体检测时间≥41d(P=0.000,OR=2.873,95%CI 1.612-5.119)、初诊PLT计数<20×109/L(P=0.008,OR=2.164,95%CI 1.225-3.822)、妊娠史(P=0.002,OR=6.734,95%CI 1.993-22.751)、入院前的输血史(P=0.001,OR=2.746,95%CI 1.531-4.925)、入院后PLT输注>30U(P=0.006,OR=3.459,95%CI 1.416-8.451)与抗HLA-Ⅰ+Ⅱ类抗体的产生有关。结论年龄较大、病程较长、PLT计数较低、有妊娠史和输血史、PLT输注总量较多,均是影响抗HLA抗体产生的危险因素。因此,对移植前血液病患者宜根据情况检测抗HLA抗体,这对于指导供者选择、监测抗体变化和改善移植预后具有重要价值。

Objective To explore the risk factors for the production of anti-HLA antibodies in patients with hematological diseases before hematopoietic stemcell transplantation.Methods The results and clinical data of 1008 patients with hematological diseases in our hospital who underwent anti-HLA antibody testing were collected by using Luminex technology platform before transplantation from 2016 to 2018 for statistical analysis.Results The total positive rate of anti-HLA antibodies in 1008 patients was 24.08%.Multivariate analysis showed that independent risk factors associated with the production of anti-HLA antibodies included age≥30 years old(P=0.046,OR1.467,95%CI1.007-2.136),time from disease diagnosis to antibody testing≥41 days(P=0.000,OR1.830,95%CI1.306-2.565),initial platelet count<20×109/L(P=0.020,OR1.543,95%CI1.072-2.220),prior pregnancy(P=0.000,OR5.187,95%CI3.689-7.293),transfusions before admission(P=0.001,OR1.762,95%CI1.257-2.470)and total platelet transfusion volumes after admission≥30 U(P=0.000,OR 2.352,95%CI1.638-3.376).Age≥30 years old(P=0.023,OR=1.839,95%CI1.088-3.108)and prior pregnancy(P=0.042,OR=5.258,95%CI1.062-26.038)are associated with the production of anti-HLA classⅠand classⅡantibodies,respectively.The time from disease diagnosis to antibody testing≥41 days(P=0.000,OR=2.873,95%CI1.612-5.119),initial platelet count<20×109/L(P=0.008,OR=2.164,95%CI1.225-3.822),prior pregnancy(P=0.002,OR=6.734,95%CI1.993-22.751),transfusions before admission(P=0.001,OR=2.746,95%CI1.531-4.925)and total platelet transfusion volumes after admission>30 U(P=0.006,OR=3.459,95%CI1.416-8.451)are associated with the production of anti-HLA classⅠandⅡantibodies.Conclusion Older age,longer course of disease,lower PLT count,history of pregnancy and blood transfusion,and higher total amount of PLT transfusion are risk factors which affect the production of anti-HLA antibodies.Therefore,it is advisable to test for anti-HLA antibodies according to the situation before transplantation,which is of great value in guiding donor selection,monitoring antibody changes and improving transplant prognosis.