影响单采献血者保留的相关因素分析

目的 探讨影响单采血小板献血者保留的相关因素.方法 选择2015年1月1日到2015年12月31日到北京市血液中心成功捐献血小板的10 160例献血者作为研究对象,采集每个献血者的特征信息,即献血者献血时年龄、性别、献血状态(初次、非初次)和是否发生献血不良反应,分析其与下一年度献血者保留相关的两个变量的关系,即再次献血(是,否)和重复捐献的次数.结果 年轻献血者(＜25岁)献血返回率(26.4％)低于非年轻献血者返回率(47.2％),返回后献血次数低;女性献血者返回率(22.5％)低于男性献血者返回率(3.5％),返回后献血次数低;初次献血者返回率(24.3％)明显低于非初次献血者返回率(58.8％),返回后献血次数低,差异均有统计学意义(P＜0.001);是否发生不良反应与献血者返回无关(P＞0.05).结论 年轻、女性、初次献血与献血者返回呈负相关.建议针对这3类献血者采取相应措施增加单采献血保留率.     

Trends in incidence and prevalence of major transfusion-transmissible viral infections in US blood donors, 1991 to 1996. Retrovirus Epidemiology Donor Study (REDS)

CONTEXT: Evaluating trends in blood donor infectious disease rates is essential for monitoring blood supply safety and donor screening effectiveness. OBJECTIVE: To determine changes over time in blood donor population infection rates of human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), hepatitis C virus (HCV), and hepatitis B virus (HBV). DESIGN: Cross-sectional survey data from the National Heart, Lung, and Blood Institute-sponsored Retrovirus Epidemiology Donor Study. SETTING: Five blood centers in different regions of the United States. PARTICIPANTS: A total of 1.9 million volunteer blood donors with 1 or more nonautologous donations from January 1991 to December 1996. MAIN OUTCOME MEASURES: Changes in rates of HIV, HTLV, HCV, and HBV infections were evaluated by comparing yearly prevalence estimates (per 100,000 donations) for first-time allogeneic donors and period-specific incidence rates (IRs) (per 100,000 person-years) for repeat allogeneic donors between 1991 and 1996 (for HCV, from about March 1992 to June 1996). RESULTS: Prevalence of HIV decreased in first-time donors from 0.030% to 0.015% (P=.006) and HCV prevalence decreased from 0.63% to 0.40% (P<.001). Trends were not statistically significant for the proportion of first-time donors with hepatitis B surface antigen (HBsAg) or HTLV. For repeat donors, IRs did not change significantly, indicating a stable but low level of seroconversion. The overall IRs (95% confidence intervals) per 100,000 person-years were 2.92 (2.26-3.70) for HIV, 1.59 (1.12-2.19) for HTLV, 3.25 (2.36-4.36) for HCV, and an estimated 10.43 (7.99-13. 37) for HBV (based on an HBsAg rate of 2.66 [2.04-3.41] with presumed false-positive results considered negative). The HBV IR estimate with presumed false-positive results considered positive (for comparability to previous analyses) was 17.83 (14.60-21.56). CONCLUSION: The decrease in HIV and HCV prevalence rates, combined with the previously documented lower rates of infection in first-time donors compared with the general population, suggests the continued benefit of behavioral risk factor screening. JAMA. 2000;284:229-235     

Prevalence, donation practices, and risk assessment of blood donors with hemochromatosis

CONTEXT: Despite changes in eligibility policies, practical barriers limit blood donations from individuals with hemochromatosis. Increased knowledge of hemochromatosis donor characteristics may help foster further changes that will promote more donations. OBJECTIVES: To estimate the prevalence of donors diagnosed as having hemochromatosis and to compare rates of unreported deferrable risks for transfusion-transmissible viral infections (TTVIs), positive screening test results for TTVIs, and donation patterns between hemochromatosis patient donors and donors reporting no medical conditions necessitating phlebotomy (non-health-related donors). DESIGN: An anonymous mail survey conducted in 1998 as part of the ongoing Retrovirus Epidemiology Donor Study. SETTING AND PARTICIPANTS: Among a stratified probability sample of 92 581 blood donors from 8 geographically diverse US blood centers, 52 650 (57%) responded. MAIN OUTCOME MEASURES: Prevalence of hemochromatosis among blood donors; prevalence of unreported deferrable risks and positive screening test results for TTVIs among hemochromatosis patient donors vs non-health-related donors. RESULTS: One hundred ninety-seven respondents (0.4%) identified themselves as hemochromatosis patients and 50 079 (95.1%) as non-health-related donors. An estimated 0.8% of all donations were from hemochromatosis patients, 45.8% of whom reported that they had donated blood to treat their illness. The proportion of repeat donors was higher in hemochromatosis patients than in non-health-related donors (83.5% vs 76.5%; P =.03). Among repeat donors, 68.7% of hemochromatosis patients reported donating at least 3 times in the past year compared with 49.1% of non-health-related donors (P<.001). The prevalence of unreported deferrable risks for TTVIs was similar in hemochromatosis patients (2.0%) and non-health-related donors(3.1%) as was the overall prevalence of positive screening test results (1.3% of hemochromatosis patients vs 1.6% of non-health-related donors). CONCLUSIONS: Although significant numbers of hemochromatosis patients reported donating blood for therapeutic reasons, our findings suggest that this population does not present a greater risk to blood safety than other donors.     

Human immunodeficiency virus antibodies in sera of Australian blood donors: 1985-1990

OBJECTIVE: To describe the results of human immunodeficiency virus type 1 (HIV-1) antibody testing of blood donations in Australia. DESIGN: Blood transfusion services tabulated the number of HIV-1 antibody tests carried out on blood donations and the number of donations found to be positive, from 1985 to 1990. SETTING: All blood transfusion services in Australia. PARTICIPANTS: All donors of blood in Australia from 1 May 1985 to 31 December 1990. OUTCOME MEASURES: The proportion of blood donations found to have HIV-1 antibody, according to State or Territory, year of donation and, when available, age, sex and donation status (repeat or first-time) of the donor. RESULTS: To the end of December 1990, 5,367,970 donations had been tested for HIV-1 antibody, and 46 were found to have the antibody, giving an overall prevalence rate of 0.86 per 100,000 donations. The highest rate was recorded in New South Wales, followed by Western Australia, and four of eight Australian States and Territories reported no donors with HIV-1 antibody. There has been no clear trend with time, but the rate is about 20% higher for 1989-1990 than for 1985-1986. Of donors found to have HIV-1 antibody, 67% were male and 33% female, and 41% reported no known or potential exposure to HIV-1 other than heterosexual contact. Among blood donors in two major Australian cities, the overall prevalence of HIV antibody was higher in those who were male, younger, and first-time donors. There has been a recent increase in the number of blood donors with HIV-1 antibody who were women reporting heterosexual contact as their only potential exposure. CONCLUSION: The rate of HIV-1 antibody in Australian blood donations remains very low and shows no clear temporal trend, but specific donor characteristics define higher rates of antibody prevalence.     

Autologous blood donations prior to elective cardiac surgery. Safety and effect on subsequent blood use

Blood transfusions are frequently necessary for patients having open heart surgery. Although autologous blood is free of such risks as transfusion-transmitted diseases, the safety and effectiveness of autologous donations by cardiac patients are debated. We analyzed the records of 291 consecutive patients undergoing elective open heart surgery. One hundred seven (36.8%) donated between 1 and 6 U of autologous blood (mean, 3.0 +/- 1.5 U) before undergoing surgery. First-time elective coronary artery bypass surgery was the most common indication for autologous donation (90.6% of autologous donors). Problems following donations were infrequent (2 of 326 donations) and without long-term consequences. Among patients having coronary artery bypass surgery who donated autologous blood, 27% required homologous blood transfusions as compared with 82% of other patients undergoing the same procedure. We conclude that autologous blood donations are safe for patients with cardiac disease and effective in significantly reducing homologous blood needs in patients undergoing elective coronary artery bypass surgery.     

Use of blood donation history of people with HIV infection to identify recipients at risk.

OBJECTIVE: To determine whether previous blood donations from HIV-positive patients posed a threat to recipients. DESIGN: Interviewer-administered questionnaire survey. SETTING: Regional HIV outpatient referral clinic for southern Alberta. PATIENTS: All 478 patients attending the clinic from May 1, 1993, to Mar. 31, 1994; 366 were excluded: 335 had not donated blood, and 31 could not provide reliable information regarding possible donations. INTERVENTIONS: Patients were asked at a routine clinic visit regarding the dates, frequency and location of previous blood donations. The Canadian Red Cross was informed, with patient consent, if the previous donations posed a potential risk of HIV transmission. OUTCOME MEASURES: Number of HIV-positive patients whose donations posed a possible or definite risk to recipients. RESULTS: A total of 545 units of blood had been donated by the 112 patients in the study; 57 units (donated by 29 patients) posed a possible risk, and 12 (given by 11 patients) posed a definite risk of HIV transmission to the recipients. Thirty-two of these donors had been unknown to the Red Cross through its "look-back" and "trace-back" protocols. Only 1 of the 13 patients found to be HIV positive by the Red Cross openly admitted donating blood to undergo HIV antibody testing; the remainder were either ill-informed or did not perceive themselves to be at risk. The patients were highly mobile, 36.7% donating blood at some time in a province other than the one where they had received their positive HIV test result. CONCLUSION: Asking HIV-positive patients about their blood donation history, although subject to recall bias, is a simple and inexpensive method for identifying high-risk blood donations. The Red Cross should routinely be notified, with patient consent, of all donations posing a risk in order to enhance the prospect for identifying HIV-positive blood recipients.     

Risk of HIV infection from blood transfusion in Montreal

OBJECTIVES: To determine the incidence (including associated donor characteristics and time trends) of HIV infection among repeat blood donors and to estimate the risk of HIV transmission from blood transfusion in Montreal and in Canada as a whole. DESIGN: Retrospective cohort analysis. SETTING: Montreal Centre Blood Transfusion Service. PARTICIPANTS: People who donated blood at least twice after Nov. 1, 1985, and at least once from Apr. 1, 1989, to Mar. 31, 1993. INTERVENTION: Blood was screened for HIV by enzyme-linked immunosorbent assay and results were confirmed by Western blot analysis. OUTCOME MEASURES: Incidence density (the incidence rate per person-time) of HIV infection among repeat blood donors by sex, age group and region of residence, and incidence density and risk among first-time donors and for Canada as whole. RESULTS: There were 200,196 eligible donors and 432,631 person-years (PY) of observation. From 1989 to 1993, there were 18 HIV seroconversions among repeat donors. The crude incidence density was 3.3 per 100,000 PY (95% confidence interval [CI] 1.8 to 5.4 per 100,000 PY); it was 4.9 per 100,000 PY among men and 0.61 per 100,000 PY among women. Age-specific incidence per 100,000 PY was 2.5 among those 12-29 years of age, 5.1 among those 30-49, 2.9 among those 40-49, and 1.4 among those 50 and older. Based on an estimated mean "window period" (from when a donor's blood is capable of transmitting HIV until detectable antibody appears) of 25 days, the current risk of HIV infection from repeat donors in the window period is estimated at 1 in 440,000. Inclusion of blood units from first-time donors produces an overall risk of 1 in 390,000 (95% CI 1 in 250,000 to 655,000). The estimated risk per blood unit in Canada as a whole is 1 in 913000 (95% CI 1 in 507,000 to 2,050,000). CONCLUSIONS: This "sentinel" population of repeat blood donors is subject to important trends in HIV spread. Therefore, estimating the incidence density of HIV infection in repeat donors provides insight into the epidemiologic characteristics of HIV infection at minimal expense. As a result of measures to improve blood safety, including HIV testing, the incidence of HIV infection among blood donors in Canada is low and the risk of HIV transmission from transfusion is extremely small, although not zero.     

无偿献全血不良反应相关因素调查分析

目的调查分析无偿献全血不良反应相关因素,统计分析其与不良反应的相关程度,为减少不良反应发生率,改进采血工作提供依据。方法调查2012-12～2013-12间150例无偿献全血者不良反应资料,并于同期向无不良反应献全血者随机发放并收集150份有效调查问卷,两者调查内容相同,均为不良反应相关因素。用统计软件SPSS15.0依次进行单因素和多因素非条件Logistic逐步回归分析。结果精神因素（包括紧张、恐惧等）、情绪低落、饥饿等11个因素与献全血不良反应有相关性,除年龄外,其余相关因素均入选多因素非条件Logistic逐步回归方程。献血不良反应中初次献血者占82%,初次献血者和重复献血者引起不良反应的因素有明显差异。结论献全血不良反应与生理、心理、环境、社会各方面因素都有关联,需要我们在献血前、献血中、献血后全程、全方位做好工作。     

2015-2019 年杭州地区献血人群HBsAg流行状况

目的了解近年来杭州地区献血人群HBsAg流行及分布状况,以便进一-步改进和完善HBV感染的预防策路。方法遵循献血者知情同意,采用ELISA法分别使用两种不同厂家的试剂检测献血后标本的HBsAg。回顾性分析2015年1月至2019年12月杭州地区无偿献血人群HBsAg阳性率,对年龄性别.献血次数等不同分布组的HBsAg阳性情况进行比较。结果共检测无偿献血者741 441人,HBsAg阳性率为0.231%。2015-2019 年HBsAg阳性率分别为0.321% .0.241% .0.251% .0.179% .0.172% ,差异有统计学意义(P<0.001)。将无偿献血人群分为18-2425-34.35-44.45--5455-60岁年龄组,各年龄组随着年龄增加献血人群比例下降,HBsAg阳性率存在差异,其中45-54岁年龄组阳性率最高(0.512%) ,差异有统计学意义(P<0.001)。男、女献血者HBsAg阳性率分别为0.271%和0.168% ;初次献血者阳性率为0.336% ,两次献血的人群阳性率为0.017%,两者差异均有统计学意义(P<0.001)。结论杭州地区无偿献血人群HBsAg阳性率低,不同年龄.性别和献血次数人群的阳性率存在差异,提高重复献血者率有利于提升血液安全。     

39例多次献血者与正常人骨髓巨核细胞对照观察

本文对39例献血在20次以上,年龄25～51岁的献血员及未献血者正常成人的骨髓巨核细胞进行了对比观察,结果表明两者之间无显著性差异。供血者巨核细胞形态未见病理性变化,其数目也不随性别、年龄及献血次数而增减。这表明供血者每三个月供血300亳升,长期供血并不影响巨核细胞的功能。     

无偿献血服务需求未满足状况及献血促动因素调查

目的:了解无偿献血服务需求未满足状况及无偿献血促动因素,探索有效促进无偿献血招募思路.方法:采用问卷形式,对献血者和非献血者服务需求未满足情况及献血促动因素进行调查.结果:献血者献血服务需求较高;献血者主要需求是获得足够的尊重,而非献血者的主要需求是献血途径和献血知识的认知;献血者献血服务需求未满足情况主要有:没有受到足够的尊重或对血站印象不好、自己献血对血站意义不大、找不到可以带领自己去献血的人、献血程序繁琐等,献血的主要原因是奉献爱心;而非献血者献血服务需求未满足情况主要有不清楚怎么献血、对血站系统不熟悉、没人要求自己献血,不献血的主要原因是没有社会压力.结论:加强血站的自身建设,提高服务水平、加大献血知识宣传力度,提高人们对献血重要性的认识、利用社会压力,鼓动人们广泛参与献血是当前强化献血招募的重要举措.     

Demanding pure motives for donation: the moral acceptability of blood donations by haemochromatosis patients

Blood banks all over the world attempt to cover the demand for blood by donations from voluntary non-remunerated donors. The discussion regarding the acceptability of blood donations by haemochromatosis patients focuses on the question of whether health benefits violate the rule of the altruistic donor. Utilitarian and deontological arguments for and against the policy of accepting blood donors who need to let blood regularly in order to stay healthy are considered by this article. A closer look at the procedure reveals that the confusion is due to the conflation of, on the one hand the phlebotomy, and on the other hand, the decision about the destination of the blood afterwards. The health benefits are connected to the phlebotomy and not to the donation. The morally relevant point in the decision as to whether the candidate is a truly altruistic donor is whether he donates without asking for a benefit in return. It is concluded that haemochromatosis patients can be free, voluntary, and altruistic blood donors.     

Prevalence of HIV-1 in blood donations following implementation of a structured blood safety policy in South Africa

Context  The South African National Blood Service collects more than 700 000 units of blood annually from a population in which 11.4% is infected with human immunodeficiency virus 1 (HIV-1). The prevalence of HIV-1 in blood donations increased to 0.26% (1:385) in 1998, indicating that a significant number of window-period infective units were entering the blood supply (risk 3.4/100 000). Objectives  To determine whether the implementation of a new donor selection policy and educational program introduced in 1999 was associated with reductions in the incidence and prevalence of HIV-1 in blood donations and the reduced transmission risk. Design  We compared the prevalence of HIV-1 in 880 534 blood donations collected from 1999 through 2000 with the 791 639 blood donations collected from 2001 through 2002. We estimated the incidence of HIV-1 in 93 378 (1999-2000) and 67 231 (2001-2002) first-time donations and the residual risk for all donations in 2001-2002 using the less-sensitive enzyme-linked immunoassay and incidence-window period model. Setting  All blood donors in the Inland region of the South African National Blood Service were analyzed. Intervention  Donor clinics in high HIV prevalence areas were closed. Programs targeting repeat donors and youth were initiated and HIV risk behavior education programs were developed. Structured donor interviews and an enhanced donor self-exclusion questionnaire were institutionalized. Results  The prevalence of HIV-1 in blood donations declined from 0.17% in 1999-2000 to 0.08% in 2001-2002 after the implementation of the new donor selection and education policy. The number of high-risk donations collected decreased from 2.6% to 1.7% (P<.001), and the likelihood of these donations being infected decreased from 4.8% to 3.25%. The likelihood of first-time donors being recently infected with HIV-1 decreased from 18% to 14% (P = .07) and respective incidence of high-risk donations collected decreased from 2.6% to 1.7%. Donations from the majority black population declined from 6.6% to 4.2% (P<.001). Analysis of HIV-1 incidence in 2001-2002 suggests a residual risk of collecting a window period infectious unit of 2.6/100 000. Conclusion  The implementation of enhanced education and selection policies in South Africa was associated with decreased prevalence of HIV-1 in blood donations.      

Retrospective audit of blood donation at a hospital-based blood centre. Implications for blood product supply and safety

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6711 (30.8%) were rejected as donors. Females accounted for 3,054 (45.6%) of rejected donors while 3,647 (54.4%) were males. Females were rejected primarily because of low haemoglobin levels, while rejection of males was most frequently attributed to symptoms of the common cold and recent drug use. One hundred and two rejected donors (1.5%) admitted to recent treatment for a sexually transmitted disease, and 138 (2.0%) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2%) and 53 (0.3%) were autologous donations. Seven hundred and four units (4.6%) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5% for HTLV-1, 0.9% for Hepatitis B and 0.4% for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8% of the national blood supply for the period under study.     

郑州市公民献血状况分析

目的 :了解郑州市公民无偿献血状况及特点 ,明确今后开展无偿献血活动的工作思路。方法 :对郑州市无偿献血状况进行调查。对 1998年 10月 1日至 2 0 0 0年 5月 1日郑州市无偿献血的人次、献血量、职业、年龄、性别等统计数据进行分析。结果 :从职业上看 ,献血人群主要集中在工人、学生、干部 ,农民献血人数较少 ;从年龄上看 ,年龄在 2 0～ 2 5岁之间的公民献血量最高 ,随着年龄的增长 ,献血量随之下降 ;从性别上看男性总献血量高于女性。结论 :郑州市无偿献血工作取得了质的飞跃 ,实现了由有偿献血到无偿献血的平稳过渡。在今后的工作中 ,既不放松对城市居民的宣传力度 ,也要加大对农民群众的宣传 ;同时要加强献血知识、血液常识的宣传     

Failure of routine HIV-1 tests in a case involving transmission with preseroconversion blood components during the infectious window period

CONTEXT: Current screening practices for blood donations have been successful in reducing human immunodeficiency virus (HIV) transmission through receipt of contaminated blood products. However, HIV-infected blood donations made prior to seroconversion and before high levels of viral replication occur could test negative using both serologic antigen and antibody tests. Testing based on nucleic acid amplification (NAT) is being implemented to screen for HIV-infected blood donated during this period, yet the issue of single vs minipool donation screening remains unresolved. OBJECTIVES: To determine HIV-1 genetic linkage between virus in 2 HIV-1-infected recipients of blood components and virus in the donor, who was HIV antigen and antibody negative at the time of donation; to screen the blood donor's plasma with HIV NAT assays, including those currently proposed for use in US blood donation screening. DESIGN AND SETTING: Case study conducted in October 1997 involving the Communicable Disease Centre, Singapore General Hospital, and the Singapore Blood Transfusion Service, Singapore. SUBJECTS: The blood donor and the 2 recipients of donor platelets and red blood cells. MAIN OUTCOME MEASURES: Genetic analysis of the HIV-1 p17 coding region of gag and the C2V5 region of env to determine the genetic relatedness of virus from the donor and recipients; reactivity in quantitative and qualitative assays, and reactivity in donor screening HIV NAT assays in single donation and minipool screening contexts. RESULTS: Direct DNA sequencing demonstrated identical HIV-1 subtype E viral sequences in the donor and recipients. Based on comparisons of a qualitative and quantitative assay for HIV-1 RNA levels, a low level of viremia (range, 5-39 copies/mL in plasma) was estimated to be in the donor's undiluted blood at the time of donation. Additional testing using donor-screening NAT assays showed consistent detection of HIV RNA in the undiluted donor plasma whereas detection was inconsistent at the 1:16 and 1:24 dilution levels currently used in minipool screening of blood donations in the United States. CONCLUSIONS: Transmission of HIV from a blood donor to a platelet recipient and a red blood cell recipient occurred in the preseroconversion infectious window period. The viral load in the implicated donation was estimated to be less than 40 copies/mL of plasma. Current US minipool HIV NAT screening protocols may not be sufficiently sensitive to detect all infectious window-period donations. JAMA. 2000;284:210-214     

Blood and plasma donations among a cohort of intravenous drug users

We evaluated the blood and plasma donation histories of a cohort of 2921 intravenous drug users in Baltimore, Md, and correlated these histories with their human immunodeficiency virus (HIV) serologic status, numbers of CD4 lymphocytes in the peripheral blood, and stigmata of intravenous drug use (scarred veins). Of the 793 intravenous drug users (27.1%) who had donated blood or plasma, 652 (82.2%) donated after they had started using intravenous drugs. Most subjects donated at commercial plasma centers, where they were paid $10 to $15 per donation. Although the HIV-1 seroprevalence of the entire cohort was 24.1%, the HIV-1 seroprevalence among those reporting plasma or blood donations declined progressively with time, from 17.1% in those who last donated in 1985 to 3.6% in those who last donated in 1988-1989. Many of the 437 intravenous drug users who had donated plasma or blood since 1985, when screening for HIV-1 was initiated, had not been notified and counseled about their HIV test results. Current programs to exclude individuals with a history of intravenous drug use from the plasma donor pool should be reevaluated and improved.     

55岁以上活体供肾移植中供受者肾功能的恢复特点

目的 探讨使用年龄≥55岁的活体供肾肾移植的临床特点、疗效及安全性.方法 对北京朝阳医院近年完成的19例供者年龄在55岁以上的活体供肾肾移植手术进行回顾性研究.19例供者平均年龄58岁,肌酐清除率(Ccr)平均(81.7±2.2)ml/min;19例受者平均年龄34岁,血液透析时间平均4个月.移植肾术中常规0点穿刺行组织学检查.结果 全部供者均平稳度过围手术期,未发生任何手术并发症,血肌酐术后1周均在正常范围内.术后1年血肌酐和Ccr分别与术后1周和6个月时比较差异无统计学意义.血压和血糖无明显变化,尿蛋白(-).所有受者肾功能早期恢复,无移植物功能延迟恢复(OGF)发生.7例接受Ccr低于80 ml/min供者肾源的受者术后血肌酐下降相对缓慢.在19例供肾中,3例肾小球硬化超过10%.结论 肾源紧缺是目前制约肾移植发展的重要因素,放宽对活体供者年龄的限制无疑会扩大肾源,挽救更多尿毒症患者;高龄供者的活体肾移植是安全可行的.     

公民死亡器官捐献潜在供体转运通道建立及供体重症监护室器官维护

目的 探讨适合临床的公民死亡器官捐献(DCD)潜在供体转运通道及供体重症监护室供体维护机制.方法 首都医科大学附属北京佑安医院自2012年1月开通转运通道,至2016年6月,器官获取组织(Organ Procurement Organization,OPO)共接到DCD相关信息152例,评估152例.临床判定为潜在捐献者合格84例,访谈84例,41例潜在供体家属同意捐献.建立DCD潜在供体转运通道,一般流程下直接转运潜在供体入供体重症监护室(DI-CU),并立即进行各重要器官的评估及维护.当潜在供体在转运过程中出现生命体征的恶化,紧急情况下启动应急流程.评价潜在供者进入DICU时和捐献前各项实验室检查指标的变化.结果 自2012年首都医科大学附属北京佑安医院共接收潜在供体41例,其中男29例,女12例;年龄(35.17±19.51)岁.1例(2.4％)转运过程中出现呼吸心跳停止,3例(7.3％)因家属意愿改变而中止捐献,37例(90.2％)顺利完成器官捐献.按中国心脏死亡器官捐献分类标准进行分类,此37例中国际标准化脑死亡供体28例(75.7％),国际标准化心脏死亡供体3例(8.1％),国际标准化心脑死亡供体6例(16.2％).其中31例供体捐献器官用于移植,6例供体的器官捐献后因损伤超出标准被弃用.潜在供体入DICU时和捐献前各项化验指标变化,AST、T-BIL、D-BIL、BUN的差异有统计学意义(P＜0.05).结论 建立适合临床工作的公民死亡器官捐献潜在供体转运通道及供体重症监护室以维护器官功能、提高捐献成功率非常重要,保证了供体器官的数量及质量.     

亲属肾移植患者术后肾功能与HLA配型和PRA相关性研究

目的研究活体亲属肾移植受者人类白细胞抗原(human leukocyte antigen,HLA)配合率、群体反应性抗体(panelreactive antibody,PRA)的产生和肾功能变化对移植肾存活的影响。方法将336例活体亲属肾移植患者分为5组:①父母给子女供肾组(118例)。②子女给父母供肾组(12例)。③兄弟姐妹间供肾组(107例)。④其他亲属供肾组(92例)。⑤夫妻间供肾组(7例)。进行HLA供受者配合率分析,并于肾移植术后1-4年追踪肾功能变化和PRA产生的情况。HLA分型检测采用美国One lanmbda公司提供的HLA-PCR-SSP分型试剂盒。PRA采用美国莱姆德公司和美国GTI公司提供的酶联免疫吸附试剂盒检测。结果第1组的118例肾移植供受者HLA-A、B、DR、DQ抗原单体型半相合,其中有22例抗原配合率高于单体型半相合。肾移植术后有36例患者出现肾功能下降,其中8例为PRA阳性。第2组的12例肾移植供受者HLA-A、B、DR、DQ抗原单体型半相合,其中有7例HLA抗原配合率高于单体型半相合。肾移植术后1例患者肾功能下降,且为再次肾移植患者。第3组的107例兄弟姐妹间HLA-A、B、DR、DQ配型完全相配合有18例,73例为单体型半相合或大于单体型半相合,其余为低于单体型半相合或不相合。肾移植术后中有13例患者肾功能下降,其中3例PRA阳性。第4组的92例其他亲属移植的供受者间HLA-A、B、DR、DQ等于或大于单体型半相合的有24例,完全不相合的有9例,虽然HLA抗原配合率大于4个抗原,但并不是单体型半相合抗原的有8例,等于或小于3个抗原配合的有51例。肾移植术后有11例患者肾功能下降,其中6例患者PRA阳性。第5组的7例夫妻间肾移植患者,HLA配合率均≤3个抗原。肾移植术后有2例患者肾功能下降,且为PRA阳性。结论父母、子女及兄弟姊妹等直系亲属肾移植供受者中HLA配合率高于其他亲属间移植供受者,但兄弟姊妹间HLA配型完全相同的则较低。HLA配型与近期移植肾存活无关,而与供者的年龄有关。良好的HLA配型与肾移植术后PRA生成的概率低有关。