输注辐照血小板后血液病患者免疫参数变化的临床观察

目的研究输注辐照血小板后患者体液免疫参数的变化以及这些免疫参数与血小板无效输注（PTR）的相关性。方法选取多次输血的恶性血液病患者随机分为观察组和对照组,分别输注γ辐照机采血小板和普通机采血小板,比较两组输注的有效率和输血不良反应的发生率,检测输血前后免疫球蛋白（IgG、IgM、IgA）、补体（C3、C4）、循环免疫复合体（CIC）、C反应蛋白的变化。分析发生无效输注患者的免疫参数特点。结果输注机采血小板后血清免疫球蛋白（IgG、IgM）、补体（C3、C4）、CIC在观察组变化差异不大（P〉0.05）;在对照组明显升高（P〈0.05）;两组输血后CRP均明显升高,IgA均无明显变化。观察组的输注有效率84.9%,与对照组56.1%相比差异有统计学意义,输血不良反应的发生率也明显减低。对血小板无效输注（PTR）患者进行分析,输血前其血清（IgG、IgM）、补体C3、CIC水平异常者比例较高,PTR患者在输血后体液免疫指标升高更明显（P〈0.05）。结论免疫球蛋白（IgG、IgM）和补体（C3、C4）、CIC、CRP可能参与了血小板无效输注,输注γ辐照机采血小板可以在一定程度上减轻患者的体液免疫反应,提高输注效率。

Clinical Observation on the Changes of Serum Immune Parameter in Patients with Hematological Malignancies Transfused with Irradiation Aphaeresis Platelet

Objective Research on the changes of serum immune parameter in patients with hematological malignancies transfused with γ irradiation aphaeresis platelet,and relationship between immune parameters and platelet transfusion refractoriness(PTR).Methods 119 patients with hematological malignancies who needed the platelet transfusion repeatedly,were divided into two groups(observation group and control group).They were transfused with irradiation aphaeresis platelet and ordinary aphaeresis platelet.Compared with transfusion effectiveness and the incidence of transfusion reaction in two groups.Immunoglobulin(IgG,IgM,IgA),complement(C3,C4),circulation immunity complex(CIC),C response protein(CRP) were monitored in patients before and after transfusion.And the characteristics of immune parameters in patients of PTR were analyzed.Results After blood transfusion,immunoglobulin(IgG,IgM),complement(C3,C4),CIChadnoobviouschangeinobservationgroup(P>0.05),whichincreasedincontrolgroup(P<0.05).CRP increased in two groups,IgA had no obvious change.84.9% of patients in observation group had effective transfusion,56.1% of patients in control group had effective transfusion.The incidence of transfusion reaction was low in observation group.Two groups had statistics significances.The abnormal ratios of IgG,IgM,C3,CIC were high in patients of PTR,immune parameters increased obviously after platelet transfusion in patients of PTR.Conclusions Immunoglobulin(IgG,IgM),complement C3,C4,CIC,CRP possibly participate in PTR.γ irradiation aphaeresis platelet is possible to reduce humeral immune response in a certain extent,and raises the infusion efficiency.