袁青 馮寶瑩 趙才翰 鄒勇
【摘要】目的 分析不規(guī)則抗體分布特征及產(chǎn)生的相關(guān)因素,探討其對臨床輸血的指導(dǎo)意義。方法 回顧性分析擬接受輸血治療的11 150例住院患者的不規(guī)則抗體特異性,繪制不規(guī)則抗體分布圖,并分析與不規(guī)則抗體產(chǎn)生相關(guān)因素。結(jié)果 通過抗體篩選及抗體鑒定證實,11 150例臨床擬輸血患者共檢出24例不規(guī)則抗體,陽性檢出率為0.21%。在所檢出的同種抗體中,RH血型系統(tǒng)的抗體最常見,占比為62.5%(其中抗-E 29.2%,抗-Ce 12.5%,抗-cE 12.5%,抗-C 4.2%),其次為MNS血型系統(tǒng),占比為20.8%(抗-M 12.5%,抗-N 4.2%,抗-Mia 4.2%); Lewis 系統(tǒng)抗體(抗-Lea 2例)占比為8.3%;另發(fā)現(xiàn)抗-H抗體1例,抗-E合并抗-Jkb抗體1例。不規(guī)則抗體篩查陽性患者中有輸血史、妊娠史者比例高于不規(guī)則抗體篩查陰性患者(P均< 0.05)。在疾病類型分布上,不規(guī)則抗體篩查陽性患者與陰性患者比較差異亦有統(tǒng)計學(xué)意義(P < 0.05),陽性患者中多見于婦產(chǎn)、血液和腎臟病患者。結(jié)論 不規(guī)則抗體的產(chǎn)生主要以RH血型系統(tǒng)和MNS血型系統(tǒng)為主,及時、有效地進行不規(guī)則抗體篩選和鑒定對長期輸血患者或孕產(chǎn)婦的輸血安全至關(guān)重要。
【關(guān)鍵詞】血型;不規(guī)則抗體;抗體鑒定;分布特征
Distribution characteristics and clinical significance of irregular antibodies Yuan Qing, Feng Baoying, Zhao Caihan, Zou Yong. Department of Blood Transfusion, the Third Affiliated Hospital of Sun Yat-sen? University,
Guangzhou 510630, China
Corresponding author, Zou Yong, E-mail: zouyong0205@163.com
【Abstract】Objective To analyze the distribution characteristics and related factors of irregular antibodies and investigate the guiding significance for clinical blood transfusion. Methods The specificity of irregular antibodies of 11 150 hospitalized patients scheduled to receive blood transfusion was retrospectively analyzed. The distribution map of irregular antibodies was drawn. The related factors of the production of irregular antibodies were analyzed. Results Antibody screening and identification confirmed that irregular antibodies were detected in 24 of 11 150 patients scheduled to receive clinical blood transfusion, with a positive detection rate of 0.21%. Among all irregular antibodies detected, the antibodies in the RH blood group system were the most common antibodies, accounting for 62.5% (29.2% of anti-E, 12.5% of anti-Ce, 12.5% of anti-cE, and 4.2% of anti-C), followed by the antibodies in the MNS blood group system, accounting for 20.8% (12.5% of anti-M, 4.2% of anti-N and 4.2% of anti-Mia), and the antibodies in the Lewis system (2 cases of anti-Lea) accounting for 8.3%, respectively. In addition, 1 case of anti-H antibody and 1 case of anti-E combined with anti-Jkb antibody were found. The proportion of patients who were positive for irregular antibodies with a history of blood transfusion or pregnancy was significantly higher than that of their negative counterparts (both P < 0.05). Regarding the distribution of disease types, statistical significance was observed between the positive and negative patients (P < 0.05). A majority of positive patients were diagnosed with obstetric, hematological and kidney diseases. Conclusions The irregular antibodies are mainly derived from the RH and MNS blood group systems. Timely and effective screening and identification of irregular antibodies are of significance for the safety of patients requiring long-term blood transfusion or pregnant women.
【Key words】Blood group; Irregular antibody; Antibody identification; Distribution characteristics
紅細胞不規(guī)則抗體篩選實驗現(xiàn)已成為醫(yī)院輸血科常規(guī)檢測項目,結(jié)合交叉配血試驗,對確保臨床安全輸血起到了至關(guān)重要的作用。隨著個體化精準輸血概念的提出及相應(yīng)策略的不斷發(fā)展,臨床對不規(guī)則抗體篩選和血型分型技術(shù)有了更高的要求。及時有效地掌握本地區(qū)或本院檢出的不規(guī)則抗體的分布特點及規(guī)律,可以為制定個體化精準輸血策略提供重要的參考依據(jù),從而提高輸血的安全性和有效性。本研究通過對本院11 150例擬接受輸血治療患者的不規(guī)則抗體特異性進行回顧性分析,旨在掌握其分布及產(chǎn)生規(guī)律,為今后進行RH分型為指導(dǎo)的精準輸血提供參考依據(jù)。
對象與方法
一、研究對象
回顧性分析2020年1月至2020年12月在我院擬接受輸血治療的11 150例住院患者的相關(guān)資料,篩選出24例攜帶不規(guī)則抗體患者。其中男10例(41.7%),年齡為60(50,71)歲;女14例(58.3%),年齡為36(31,41)歲,孕產(chǎn)婦8例,占女性患者的57.1%。
二、研究方法
1.? 不規(guī)則抗體篩選
采用微柱凝膠法進行不規(guī)則抗體的檢測。嚴格按說明書進行操作。實驗步驟為:取低離子抗球蛋白微柱凝膠卡(Bio-Rad)進行標記,依次加入50 μL 0.8% Ⅰ ~ Ⅲ號篩選紅細胞(Bio-Rad)及
50 μL患者血清,置37 ℃專用孵育器(ID-Incubator 37 SⅠ,Bio-Rad)內(nèi)孵育15 min,最后放入卡式專用離心機(ID-Centriguge 12 SⅡ,Bio-Rad)離心10 min 后判定結(jié)果。患者血清中如果有不規(guī)則抗體,通過孵育會致敏抗篩紅細胞,再次通過離心使紅細胞上不規(guī)則抗體與抗人球蛋白反應(yīng),紅細胞發(fā)生交聯(lián),不能通過凝膠間隙而留在凝膠管上層或分散在凝膠管中,根據(jù)紅細胞凝集的強度判斷為(+) ~ (++++)。
2.抗體鑒定
所有抗體篩選陽性且需輸血的患者標本送廣州血液中心血型研究室利用譜細胞進行抗體鑒定。在低離子抗球蛋白微柱凝膠卡(Bio-Rad)11個微柱孔中依次加入1 ~ 11號譜細胞(REAGENS)和患者血清,37℃孵育15 min,離心10 min 后根據(jù)譜細胞反應(yīng)結(jié)局判定為何種不規(guī)則抗體。鑒定結(jié)果反饋至我院輸血科。
3. 觀察內(nèi)容
分析不規(guī)則抗體的特異性分布,并根據(jù)不規(guī)則抗體篩查結(jié)果分為陽性組與陰性組,比較2組的性別構(gòu)成、年齡、輸血史、妊娠史和疾病類型分布,分析產(chǎn)生不規(guī)則抗體的相關(guān)因素。
三、統(tǒng)計學(xué)處理
采用SPSS 25.0進行統(tǒng)計學(xué)分析。非正態(tài)分布計量資料采用中位數(shù)(下四分位數(shù),上四分位數(shù))表示,計數(shù)資料采用例(%)表示,組間比較采用χ2檢驗。P < 0.05為差異有統(tǒng)計學(xué)意義。
結(jié)果
一、不規(guī)則抗體特異性分布
11 150例臨床擬輸血患者共檢出24例不規(guī)則抗體,檢出率為0.21%。在所檢出的同種抗體中,RH血型系統(tǒng)的抗體所占比例(62.5%)最高,其次為MNS血型系統(tǒng)(20.8%),Lewis 系統(tǒng)抗體(抗-Lea 2例)占比為8.3%;另發(fā)現(xiàn)抗-H抗體1例,抗-E合并抗-Jkb抗體1例,見表1和圖1。
二、不規(guī)則抗體產(chǎn)生影響因素分析
陽性組與陰性組的性別構(gòu)成、年齡構(gòu)成比較差異均無統(tǒng)計學(xué)意義(P均> 0.05)。陽性組患者中有輸血史、妊娠史者比例高于陰性組患者(P均0.05)。在疾病類型分布上,陽性組與陰性組比較差異亦有統(tǒng)計學(xué)意義(P < 0.05),陽性組中多見于婦產(chǎn)、血液和腎臟病患者,見表2。
討論
不規(guī)則抗體篩查對于保障輸血患者尤其是反復(fù)輸血的患者和有妊娠史、輸血史的孕產(chǎn)婦安全非常重要。本研究通過對我院11 150例臨床輸血患者不規(guī)則抗體篩查結(jié)果進行回顧性分析,繪制出了24例不規(guī)則抗體分布圖。本研究中不規(guī)則抗體陽性檢出率為0.21%,與既往文獻報道類似[1-2]。在這些不規(guī)則抗體中,最常見的抗體是RH系統(tǒng)抗體,占總數(shù)的62.5% ,其中抗-E 是檢出最多的同種抗體,達到29.2%,其次是抗-Ce和抗-M,分別達到12.5%。在檢出同種抗體的血液標本中,有1例同時檢出抗-E和抗-Jkb。
有報道5812例患者首次接受輸血治療后有2.8%的患者在13 ~ 248 d內(nèi)產(chǎn)生了不規(guī)則抗體[3]。在已產(chǎn)生不規(guī)則抗體的患者中,進一步輸血有21.4%患者產(chǎn)生新的不規(guī)則抗體[4]。因此多次輸血大大增加了不規(guī)則抗體產(chǎn)生風(fēng)險。目前RH血型抗體尤其是抗-E、抗-cE和抗-Ce仍然是臨床最常見且最有意義不規(guī)則抗體,也是引發(fā)遲發(fā)性溶血性輸血反應(yīng)的主要原因,抗-M和抗-Lea 則是RH血型系統(tǒng)之外最常見的同種抗體,但臨床意義明顯弱于前者。為降低不規(guī)則抗體產(chǎn)生風(fēng)險,減少遲發(fā)性溶血輸血反應(yīng)的發(fā)生,對輸血患者和供血進行RH分型檢測,做到RH血型同型輸注已迫在眉睫。
本研究中篩查出的24例不規(guī)則抗體中,抗-E比例達到了29.2%。因為已產(chǎn)生抗-E抗體的患者后續(xù)產(chǎn)生抗-c的風(fēng)險較高[5]。因此建議當(dāng)發(fā)現(xiàn)抗-E陽性時,無論患者的抗-c是陰性還是陽性,均應(yīng)提供R1R1表型(E-,c-)紅細胞,以避免進一步產(chǎn)生抗-c抗體[6]。此外,在14例不規(guī)則抗體陽性的女性患者中,有8例是孕產(chǎn)婦,達到了58.3%,與國內(nèi)相關(guān)報道一致[7]。研究結(jié)果提示孕產(chǎn)婦由于妊娠或輸血產(chǎn)生不規(guī)則抗體的概率大大增加。孕期嚴格對不規(guī)則抗體進行篩查和動態(tài)監(jiān)測,并結(jié)合RH分型精準輸血策略,對減少不規(guī)則抗體對胎兒或新生兒的傷害(新生兒溶血?。┚哂兄匾饬x。
總之,本研究通過分析我院輸血患者不規(guī)則抗體產(chǎn)生的分布特征,為今后進行RH分型為指導(dǎo)的精準輸血提供了重要的參考依據(jù),及時、有效地進行不規(guī)則抗體篩選和鑒定對長期輸血患者或孕產(chǎn)婦的輸血安全至關(guān)重要。
參 考 文 獻
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[2] 曲淑君.5379例患者ABO血型分布及不規(guī)則抗體檢測結(jié)果分析. 檢驗醫(yī)學(xué)與臨床, 2017, 14(8): 1172-1173.
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[5] Shirey R S, Edwards R E, Ness P M. The risk of alloimmunization to c (Rh4) in R1R1 patients who present with anti-E. Transfusion, 1994, 34(9):756-758.
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(收稿日期:2021-05-18)
(本文編輯:林燕薇)