血型不规则抗体检测的方法学评价

目的寻找简便、快速、敏感的用于红细胞不规则抗体筛选的试验方法。方法收集6例临床疑难病例样本和1份IgG型试剂,采用盐水法、木瓜酶法、凝聚胺法、抗人球蛋白法、微柱凝胶法平行检测患者血清中不规则抗体的效价,比较5种方法的敏感性、特异性。结果盐水法仅检出IgM类不规则抗体;木瓜酶法、凝聚胺法、抗人球蛋白法、微柱凝胶法在检测IgG类抗体效价时差异不大,木瓜酶法的敏感性略低,微柱凝胶法对弱阳性IgG抗体检测的敏感性最高,但4种方法间差异无统计学意义（P〉0.05）,相关性较好（r〉0.99）。结论盐水法不能检出IgG抗体;木瓜酶法检测IgG抗体具有一定的局限性;凝聚胺法简便、快速,但为手工操作,不易标准化;抗人球蛋白法需要反复洗涤红细胞,费时,不便于开展大规模筛查;微柱凝胶法操作简便迅速、敏感性高、重复性好、易于标准化,适于临床输血前和孕妇产前大批量抗体筛选,是检测IgG抗体最为敏感的方法。

Methodology evaluation for the determination of blood type irregular antibodies

Objective To search a simple,rapid and sensitive method for screening red blood cell irregular antibodies.Methods 7 samples with red blood cell irregular antibodies（6 from clinical cases and 1 IgG reagent） were detected by saline test,papain test,polybrene test,anti-human globulin test and microcolumn gel test.The specificities and sensitivities of 5 methods were compared.Results Only the irregular antibody of IgM nature was detected by saline test.There was no obvious difference in the titer of determining the irregular antibodies of IgG nature by papain test,polybrene test,anti-human globulin test and microcolumn gel test.The papain test was less sensitive than other 3 methods,and the microcolumn gel test was the most sensitive in the determination of the weakly positive irregular antibodies of IgG nature.There was no significant difference between the 4 methods（P0.05）,and there was a good correlation between the 4 methods（r0.99）.Conclusions The saline test is not suitable for the detection of IgG antibody.The papain test has certain limitation in determination of IgG antibody.The polybrene test is the most simple and convenient method for the determination of irregular antibodies of IgG nature,but it is not standardized easily.The anti-human globulin test is complicated because of multiple wash of red blood cells,and it is not suitable for extensive screening.The microcolumn gel test with good reproducibility and sensitivity is a simple and fast method and is standardized easily.It is suitable for clinical massive samples with the detection of IgG antibodies before blood transfusion and antenatal screening.