摘要
目的探讨Rh抗原扩展匹配对红细胞输注疗效及安全性的影响。方法选择2021年5月至2022年3月于山东阳光融和医院接受去白细胞悬浮红细胞输注的585例贫血患者(以下将其简称为"受血者")为研究对象。男性受血者为332例,年龄为(60.6±16.4)岁;女性为253例,年龄为(59.4±18.4)岁。对2021年5月至12月接受输血的358例受血者及同期从潍坊市中心血站入库的2010袋去白细胞悬浮红细胞(以下将其简称为"库存红细胞")进行Rh抗原分型检测。按照受血者与库存红细胞Rh抗原匹配程度,将这358例受血者分为相合组(n=135,选择与受血者Rh抗原完全匹配的库存红细胞输注);相容组(n=107,选择Rh抗原少于受血者的库存红细胞输注),不合组(n=116,选择Rh抗原多于受血者的库存红细胞输注)。选择2022年1月至3月本院全部227例受血者纳入对照组,该组受血者输血前未进行Rh抗原分型检测,采取RhD相合输血。本研究通过比较4组受血者输血后的红细胞计数升高值,血红蛋白(Hb)升高值、血细胞比容(HCT)升高值、输注每单位去白悬浮红细胞Hb升高量,以及输血有效率,评价输血疗效。通过比较4组受血者输血反应发生率、不规则抗体筛查结果、直接抗球蛋白试验(DAT)结果,评价其输血安全性。本研究计数资料的总体比较采用列联表χ^(2)检验或Fisher确切概率法,组间两两比较采用Bonferroni校正法;定量资料总体比较采用Kruskal-Wallis H检验,组间两两比较采用Dunn-Bonferroni检验。4组受血者的性别构成比、年龄、体重、血容量的总体比较及两两比较,差异均无统计学意义(均为P>0.05)。本研究遵循的程序符合山东阳光融和医院人体试验委员会制定的标准,经过该伦理委员会批准(批准文号:科伦审第2022100801号),并与所有受试者签署临床研究知情同意书。结果①本研究相合、相容、不合组的358例受血者和2010袋库存红细胞全部为RhD阳性,其中共检测出9种Rh抗原表型,占比居前2位的表型为CcDEe(38.2%)和CCDee(38.1%)。这358例受血者和2010袋库存红细胞的4种ABO血型中,各Rh表型在库存红细胞和受血者中的分布分别比较,差异均无统计学意义(均为P>0.05)。②本研究相合、相容、不合及对照组受血者红细胞输注量[3.0 U(3.0,4.5 U)比4.0 U(3.0,6.0 U)比3.0 U(2.0,4.0 U)比3.0 U(2.0,4.0 U)]、Hb升高值[22.0 g/L(14.0,34.0 g/L)比23.0 g/L(17.0,38.0 g/L)比16.0 g/L(7.3,26.8 g/L)比17.0 g/L(9.0,28.0 g/L)]、红细胞计数升高值[0.70×10^(12)/L(0.45×10^(12)/L,1.10×10^(12)/L)比0.74×10^(12)/L(0.50×10^(12)/L,1.27×10^(12)/L)比0.54×10^(12)/L(0.17×10^(12)/L,0.87×10^(12)/L)比0.53×10^(12)/L(0.26×10^(12)/L,0.88×10^(12)/L)]、HCT升高值[6.1%(3.8%,9.9%)比6.3%(4.8%,11.2%)比5.1%(1.7%,7.6%)比5.1%(2.6%,7.7%)]、输注1 U红细胞Hb升高量[28.3 g/U(22.2,37.1 g/U)比26.4 g/U(19.0,33.0 g/U)比21.9 g/U(11.4,32.7 g/U)比23.7 g/U(15.7,33.2 g/U)],这5个指标分别总体比较,差异均有统计学意义(H=25.12、36.12、41.19、34.98、18.93,均为P<0.001);相容组和相合组受血者这5个指标,分别高于不合组和对照组,并且差异均有统计学意义(均为P<0.001)。③本研究相合组、相容组、不合组、对照组受血者的输血不良反应发生率分别为0.74%(1/135)、0.93%(1/107)、1.7%(2/116)、0.44%(1/227),4组比较,差异无统计学意义(χ^(2)=1.49,P=0.685)。4组受血者均无新发生的不规则抗体阳性。结论Rh抗原扩展匹配白细胞悬浮红细胞输注可提高贫血患者的临床输血疗效,并且安全性良好。
Objective To investigate the efficacy and safety of Rh antigen extended matched red blood cell transfusion.Methods From May 2021 to March 2022,a total of 585 anemia patients who received leukocyte-depleted suspended red blood cell transfusion(hereinafter referred to as"recipients")in Shandong Sunshine Union Hospital were selected as research subjects.Among them,there were 332 male recipients with an age of(60.6±16.4)years old,and 253 female recipients with an age of(59.4±18.4)years old.Rh antigen typing was performed on 358 recipients who received blood transfusion from May to December 2021 and 2010 bags of leukocyte-reduced suspended red blood cells stored from Weifang Central Blood Station(hereinafter referred to as"stocked red blood cells")during the same period.According to the degree of Rh antigen matching between the recipients and the stored red blood cells,these 358 recipients were divided into the matched group(n=135,the stored red blood cells for transfusion were completely matched the recipient′s Rh antigen);compatible group(n=107,the stored red blood cells for transfusion had less Rh antigen than the recipients),and incompatible group(n=116,the stored red blood cells for transfusion had more Rh antigen than the recipients).From January to March 2022,a total of 227 recipients in this hospital were selected and included in the control group.The recipients in this group did not undergo Rh antigen typing test before blood transfusion,and received RhD-matched blood transfusion.The efficacy of blood transfusion was evaluated by comparing the increase in red blood cell count,hemoglobin(Hb),hematocrit(Hct),the increase in Hb per unit of leukoreduced suspended red blood cells transfused,and the transfusion effective rate among the 4 groups of recipients.The safety of blood transfusion was evaluated by comparing the incidence of transfusion reactions,irregular antibody screening results,and direct antiglobulin test(DAT)results among the 4 groups of recipients.The Chi-square test of independence for contingency tables or Fisher exact probability method was used for overall comparison of count data in this study,and the Bonferroni correction method was used for pairwise comparison between groups.The Kruskal-Wallis H test was used for overall comparison of measurement data,and the Dunn-Bonferroni correction method was used for pairwise comparison between groups.There were no significant differences in the gender composition,age,weight,and blood volume among the 4 groups of recipients(all P>0.05).The procedures followed in this study were in accordance with the standards established by the Committee of Investigation in Human Beings of Shandong Sunshine Union Hospital and were approved by the committee(Approval No.2022100801),and informed consents for clinical research were signed by all subjects.Results ①In this study,all 358 recipients and 2010 bags of banked red blood cells in the matched,compatible and incompatible groups were RhD positive,and a total of 9 Rh antigen phenotypes were detected,with the top two phenotypes of CcDEe(38.2%)and CCDee(38.1%).Among the 4 ABO blood types of the 358 recipients and 2010 bags of banked red blood cells,the distribution of each Rh phenotype in stored red blood cells and recipients was compared respectively,and there were no statistically significant differences(all P>0.05).②In this study,the red blood cell transfusion volume[3.0 U(3.0,4.5 U)vs 4.0 U(3.0,6.0 U)vs 3.0 U(2.0,4.0 U)vs 3.0 U(2.0,4.0 U)],increased Hb value[22.0 g/L(14.0,34.0 g/L)vs 23.0 g/L(17.0,38.0 g/L)vs 16.0 g/L(7.3,26.8 g/L)vs 17.0 g/L(9.0,28.0 g/L)],increased red blood cell count[0.70×10^(12)/L(0.45×10^(12)/L,1.10×10^(12)/L)vs 0.74×10^(12)/L(0.50×10^(12)/L,1.27×10^(12)/L)vs 0.54×10^(12)/L(0.17×10^(12)/L,0.87×10^(12)/L)vs 0.53×10^(12)/L(0.26×10^(12)/L,0.88×10^(12)/L)],increased HCT[6.1%(3.8%,9.9%)vs 6.3%(4.8%,11.2%)vs 5.1%(1.7%,7.6%)vs 5.1%(2.6%,7.7%)],increased Hb value per unit red blood cell transfusion[28.3 g/U(22.2,37.1 g/U)vs 26.4 g/U(19.0,33.0 g/U)vs 21.9 g/U(11.4,32.7 g/U)vs 23.7 g/U(15.7,33.2 g/U)]of matched,compatible,incompatible and control group were compared respectively,and the differences were statistically significant(H=25.12,36.12,41.19,34.98,18.93;all P<0.001).The above 5 indicators of recipients in compatible group and compatible group were higher than those in incompatible group and control group respectively,and the differences were statistically significant(all P<0.001).③The incidences of transfusion reactions in the matched,compatible,incompatible,and control groups were 0.74%(1/135),0.93%(1/107),1.7%(2/116),and 0.44%(1/227),respectively.There was no significant difference among the 4 groups(χ^(2)=1.49,P=0.685).And there was no new case of irregular antibody positive occurred in the 4 groups.Conclusions Rh antigen extended matching leukocyte-reduced suspended red blood cell transfusion could improve the clinical transfusion efficacy of anemic patients and has good safety.
作者
王妮娜
张洪红
高雷
王凯
李丹华
刘荣
陈昊阳
孙福廷
Wang Nina;Zhang Honghong;Gao Lei;Wang Kai;Li Danhua;Liu Rong;Chen Haoyang;Sun Futing(Department of Blood Transfusion,Shandong Sunshine Union Hospital,Weifang 261061,Shandong Province,China)
出处
《国际输血及血液学杂志》
2025年第2期167-174,共8页
International Journal of Blood Transfusion and Hematology
基金
潍坊市卫生健康委员会科研项目(WFWSJK-2022-159)。
关键词
RH-HR血型系统
血型抗原
Rh同种免疫
血液成分输血
输血反应
Rh抗原扩展匹配
输血疗效
精准输血
Rh-Hr blood-group system
Blood group antigens
Rh isoimmunization
Blood component transfusion
Transfusion reaction
Rh antigen extended matching
Transfusion efficacy
Precise blood transfusions
作者简介
通信作者:孙福廷,Email:wfrmyysft@163.com。
