摘要
目的探讨患者血小板输注效果的影响因素。方法对256名血小板减少患者输注机采血小板,输血前采用固相凝集法筛查血小板抗体,对抗体阳性者做血小板（HLA和HPA）抗体确认。以1和24 h血小板回收率（PPR）和血小板计数增高指数（CCI）判断血小板输注效果,并分析其中98例血小板输注效果不理想病例的原因,以找出血小板输注无效（PTR）的影响因素。结果本组血小板输注患者中的PTR率为38.3%（98/256）,其中男性为32.2%（39/121）、女性为43.7%（59/135）[有妊娠史者占59.3%（35/59）],超重者（25≤BMI≤29.9）为42.9%（33/77）,血小板输注次数≥3次者为53.8%（35/65）;41～70岁者占本组PTR比例的58.2%（57/98）,有抗体产生的血小板输注无效者占27.6%（27/98）,发生PTR而血小板抗体检测阴性者占71.4%（71/98）[其中存在感染者占35.2%（25/71）、发热者为33.8%（24/71）]。结论血小板同种抗体是引起PTR的重要免疫因素,而非免疫性因素造成的PTR占比更大,尤以感染和发热居多;PTR率随患者年龄、体重及输注次数增加而升高;女性患者,尤其有妊娠史者PTR率较高。
Objective To determine the factors inflecting the efficacy of platelet transfusions. Methods After transfusing platelet to 256 cases of thrombocytopenia,solid-phase agglutination method was adopted to improve the platelet antibody screening. 1 h and 24 h increased platelet recovery（ PPR） and platelet count index（ CCI） were the criterion to decide whether platelet transfusion was effective. And the 98 cases of patients whose platelet transfusion effect was not ideal had been studied for root causes,in order to obtain the factors of platelet transfusion refractoriness（ PTR）. Results The ratio of PTR was38. 3%（ 98 /256）,while the male cases was 32. 2%（ 39 /121）,the female cases was 43. 7%（ 59 /135） [the females who had history of pregnancy was 59. 3%（ 35 /59） ],the overweight patients（ 25≤BMI≤29. 9） was 42. 9%（ 33 /77）,the multiple platelet transfusion patients（ 3 or higher） was 53. 8%（ 35 /65）,the patients between 41 year old and 70 year old was58. 2%（ 57 /98）,the platelet antibody（ ＋） cases was 27. 6%（ 27 /98）,the platelet antibody（-） cases was 71. 4%（ 71 /98）,which included35. 2%（ 25 /71） of infection and 33. 8%（ 24 /71） of fever. Conclusion Platelet count has been increased obviously after the first platelet transfusion,and blood coagulation function has been improved effectively. But the improvement of patients with multiple platelet transfusion（ 3 or higher） is not obvious. The main factors of PTR are non-immunologic factors,in which the infection and fever represent significant shares,and platelet antibody is an important immune factor affecting the efficacy of platelet transfusion. PTR is increases along with the age and weight increasing. The PTR of females is higher than that of others especially who has a history of pregnancy.
出处
《中国输血杂志》
CAS
CSCD
北大核心
2014年第6期578-580,共3页
Chinese Journal of Blood Transfusion
基金
国家自然科学基金面上项目(81170530)
上海市自然科学基金面上项目(11ZR1405200)
关键词
血小板输注无效
同种异体免疫
血小板抗体
女性患者
年龄
体重
输血小板次数
感染
发热
platelet transfusion refractoriness
allogeneic immunity
platelet antibody
female patient
age
weigh
thenumber of transfusions
infection
fever
