首页|反复输血地中海贫血儿童血清免疫球蛋白水平变化及其与迟发性溶血性输血反应的相关性研究

反复输血地中海贫血儿童血清免疫球蛋白水平变化及其与迟发性溶血性输血反应的相关性研究

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目的 探讨反复输血地中海贫血儿童血清免疫球蛋白水平变化及其与迟发性溶血性输血反应(delayed hemolytic transfusion reactions,DHTR)的相关性。方法 收集2022 年6 月—2023 年4 月期间到本院接受输血治疗的地中海贫血儿童(观察组)及健康体检儿童(对照组)血清标本,运用流式细胞仪CBA多因子定量检测技术,检测血清免疫球蛋白(IgG亚类、IgM、IgA、IgE、IgD)水平,比较 2 组儿童血清免疫球蛋白差异;按照不同输血次数分为 4 组:≤10 次、11~30 次、31~50 次、>50 次,各组采用单因素方差分析比较不同输血次数与血清免疫球蛋白水平之间的差异;将DHTR的地中海贫血儿童分为溶血组,未发生DHTR的地中海贫血儿童分为非溶血组,比较 2 组儿童血清免疫球蛋白(IgG亚类、IgM、IgA、IgE、IgD)之间的变化,探讨反复输血的地中海贫血儿童血清免疫球蛋白与DHTR的相关性。结果 血清免疫球蛋白 IgG1、IgG3、IgG4、IgA 观察组明显高于对照组,分别增加了(2。07±2。12)、(0。67±2。03)、(0。30±0。37)、(6。04±11。40)mg/mL,IgD观察组明显低于对照组,降低了(0。03±0。01)mg/mL,P<0。05;IgG2、IgM、IgE 2 组之间,P>0。05。输血次数与血清免疫球蛋白之间的相关性:随着输血次数增加,IgG1、IgG4 均明显增高,4 组IgG1 依次增加(0。30±0。62)、(0。41±0。51)、(3。60±3。48)mg/mL,IgG4 依次增加(0。12±0。13)、(0。22±0。07)、(0。21±0。38)mg/mL,IgG2、IgM、IgD明显降低,4 组IgG2、IgM、IgD依次降低(0。91±1。50)、(0。14±0。10)、(0。05±0。05)mg/mL,与输血次数之间有显著差异性,P<0。05;IgG3、IgA、IgE与输血次数之间无显著差异性,P>0。05。IgG1、IgG3、IgG4溶血组明显高于非溶血组,分别增加了:IgG1(4。44±3。41),IgG3(0。73±1。26),IgG4(0。52±0。40)mg/mL,IgD溶血组明显低于非溶血组,降低了(0。00±0。06)mg/mL,P<0。05;IgG2、IgM、IgA、IgE溶血组与非溶血组之间,P>0。05。结论 反复输血的地中海贫血儿童血清免疫球蛋白水平异常;反复输血的地中海贫血儿童不同输血次数与血清免疫球蛋白之间存在相关差异性;反复输血的地中海贫血儿童发生DHTR的相关血清免疫球蛋白为IgG1、IgG3、IgG4。
Changes in serum immunoglobulin levels in children with thalassemia who undergo repeated blood transfusions and their correlation with delayed hemolytic transfusion reactions
Objective To study the changes in serum immunoglobulin levels in children with thalassemia who undergo repeated blood transfusions and explore their correlation with delayed hemolytic transfusion reactions(DHTR).Methods Serum samples from children with thalassemia who received blood transfusion treatment from June 2022 to April 2023(ob-servation group)and healthy children who underwent physical examination(control group)in our hospital were collected.The levels of serum immunoglobulins(IgG subtype,IgM,IgA,IgE and IgD)were detected using flow cytometry CBA multi-factor quantitative detection technology,and the differences between the two groups were compared.The children were divided into 4 groups according to different transfusion numbers:≤10 numbers,11-30 numbers,31-50 numbers and>50 numbers,and the differences between different blood transfusion numbers and serum immunoglobulin levels in each group were compared using one-way analysis of variance(ANOVA).Children with thalassemia with DHTR were in the hemolysis group,and children with thalassemia who did not experience DHTR were in the non-hemolysis group.The changes in serum immunoglobulins(IgG subtypes,IgM,IgA,IgE and IgD)between the two groups were compared to explore the correlation between serum immunoglobulins in thalassemia children with repeated transfusion and DHTR.Results The levels of IgG1,IgG3,IgG4 and IgA in the observation group were significantly higher than those in the control group,with the increase of(2.07±2.12),(0.67±2.03),(0.30±0.37)and(6.04±11.40)mg/mL,respectively,while the level of IgD in observation group was significantly lower than that in the control group,with a decrease of(0.03±0.01)mg/mL,P<0.05.No significant difference was noticed in IgG2,IgM and IgE between the groups(P>0.05).IgG1 and IgG4 both significantly increased with the number of blood transfusions.The IgG1 in the 4 groups increased sequentially as(0.30±0.62),(0.41±0.51)and(3.60±3.48)mg/mL,and IgG4 increased sequentially as(0.12±0.13),(0.22±0.07)and(0.21±0.38)mg/mL.IgG2,IgM and IgD showed a significant decrease,with IgG 2,IgM,and IgD in four groups decreased as(0.91±1.50),(0.14±0.10)and(0.05±0.05)mg/mL,respectively,showing significant differences with the number of blood transfusions(P<0.05).No sig-nificant difference was found in IgG3,IgA and IgE with different number of transfusions(P>0.05).IgG1,IgG3 and IgG4 in the hemolysis group were significantly higher than those in the non-hemolysis group,with an increase of(4.44±3.41),(0.73±1.26)and(0.52±0.40),respectively(P<0.05).IgD in the hemolysis group was significantly lower than that in the non-hemolysis group,with a decrease of(0.00±0.06)mg/mL,P<0.05.No significance was noticed in IgG2,IgM,IgA and IgE between the hemolysis group and the non-hemolysis group(P>0.05).Conclusion The serum immunoglobulin levels of children with thalassemia who undergo repeated blood transfusions are abnormal.There are differences in correlation between the number of blood transfusions and serum immunoglobulin levels among children with thalassemia who undergo repeated blood transfusions.The relevant serum immunoglobulins for DHTR in children with thalassemia who undergo repeated blood transfusions are IgG1,IgG3 and IgG4.

children with thalassemiarepeated blood transfusionIgG subtypenumbers of blood transfusiondelayed hemolytic transfusion reactions(DHTR)

金晓红、胡美坤、陈蕊、高立兰、王淑霞、吕孟兴、屈柯暄

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昆明市儿童医院 昆明市卫健委技术中心 云南省儿童健康与疾病临床医学研究中心,云南 昆明 650228

地中海贫血儿童 反复输血 IgG亚类 输血次数 迟发性溶血性输血反应(DHTR)

云南省昆明市卫生科技人才培养"十百千"工程项目云南省儿童健康与疾病临床医学研究中心开放课题昆明市卫生健康委卫生科研项目昆明市卫生科技人才培养项目医学技术中心建设项目

2021-SW省-024202002AA1002082022-06-04-0032022-SW技术-007

2024

中国输血杂志
中国输血协会 中国医学科学院输血研究所

中国输血杂志

CSTPCD
影响因子:1.279
ISSN:1004-549X
年,卷(期):2024.37(5)
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