【摘要】 目的 分析临床患者血浆中β-内酰胺类药物&抗体对供者红细胞的亲和力，探究药源性溶血性贫血及输血无效的临床特点。方法 选择2021年11月～2022年4月期间临床送检的4例有β-内酰胺类药物用药史的临床患者，检测ABO与Rh血型，直接抗球蛋白试验（direct antiglobulin test,DAT）、不规则抗体鉴定（identification of irregular antibodies,IAT）与β-内酰胺类药物抗体及效价，对DAT阳性的患者红细胞进行酸放散并检测放散液中β-内酰胺类药物抗体。选择ABO和Rh同型的供者红细胞与患者血浆在37℃无菌条件下体外致敏，监测β-内酰胺类药物&抗体在0,24,48和72 h与供者红细胞的亲和力，并观察加入补体后的溶血程度。结果 4例患者血浆中均存在β-内酰胺类药物抗体，停药前输血无效，停药后输血效果良好。患者1:A型，RhCCDee,DAT阳性（3+W）,IAT阴性，血浆中存在头孢哌酮药物抗体（效价：1∶64）、阿莫西林药物抗体（效价：1∶16），放散液中存在头孢哌酮药物抗体。患者2:A型，RhCcDee,DAT阳性（4+W）,IAT阴性，血浆中存在头孢哌酮药物抗体（效价：1∶128），放散液中存在头孢哌酮药物抗体。患者3:A型，RhCcDee,DAT阳性（4+）,IAT阳性，鉴定为抗E抗体，血浆中存在阿莫西林药物抗体（效价：1∶16）、亚胺培南药物抗体（效价：1∶64）、头孢哌酮药物抗体（效价：1∶128），放散液中存在亚胺培南、头孢哌酮药物抗体。患者4:A型，RhCCDee,DAT阳性（1+）,IAT阳性，鉴定为抗-E.c抗体，血浆中存在阿莫西林药物抗体（效价：1∶32），放散液中未检测到药物抗体。4例患者血浆与供者红细胞体外致敏24 h后DAT均为阳性，48和72 h内逐渐增强，加入补体后均可引起红细胞溶解。结论 头孢哌酮、阿莫西林和亚胺培南三种β-内酰胺类药物&抗体可迅速结合到供者红细胞表面并随时间延长而增强，有补体存在的条件下可在24～72 h内破坏供者红细胞引起溶血，导致输血无效。更多还原

【Abstract】 Objective To analyze the affinity of β-lactam drugs & antibodies in plasma of clinical patients to donor erythrocytes, and explore the clinical characteristics of drug-induced hemolytic anemia and ineffective transfusion. Methods From November 2021 to April 2022, 4 clinical patients with a history of β-lactam drug use were selected for detection of ABO and Rh blood group, direct antiglobulin test(DAT), irregular antibody identification(IAT) and β-lactam drug antibody and titer.Erythrocytes of DAT positive patients were dispersed with acid and β-lactam antibodies were detected in the dispersed solution.ABO, Rh isotype donor erythrocytes and patient plasma were sensitized in vitro under sterile conditions of 37 ℃. The affinity of β-lactam drugs & antibodies to donor erythrocytes at 0, 24, 48 and 72 h were monitored, and the degree of hemolysis after complement addition was observed. Results There were β-lactam antibodies in the plasma of 4 patients. Blood transfusion was ineffective before drug withdrawal, but the blood transfusion effect was good after drug withdrawal. Patient 1: type A,RhCCDee, DAT positive(3+W), IAT negative, cefoperazone drug antibody in plasma(titer:1∶64), amoxicillin drug antibody(titer:1 ∶ 16), cefoperazone drug antibody in the discharge fluid. Patient 2: type A, RhCcDee, DAT positive(4+W), IAT negative, cefoperazone drug antibody in plasma(titer:1∶128), cefoperazone drug antibody in the discharge fluid. Patient 3: type A, RhCcDee, DAT positive(4+), IAT positive, identified as anti-E antibody, amoxicillin drug antibody(titer:1∶16), imipenem drug antibody(titer:1∶64), cefoperazone drug antibody(titer:1∶128) in plasma, imipenem drug antibody and cefoperazone drug antibody. Patient 4: type A, RhCCDee,DAT positive(1+), IAT positive, identified as anti-E.c antibody and amoxicillin antibody was present in plasma(titer:1∶32), but no drug antibody was detected in the release fluid. After sensitization of plasma and donor erythrocytes in vitro for 24 h, DAT was positive in all the 4 patients, and it was gradually enhanced within 48 h and 72h. The addition of complement could cause erythrocyte lysis in all the 4 patients. Conclusion Cefoperazone, amoxicillin and imipenem were three β-lactam drugs & antibodies can bind to the surface of donor erythrocytes rapidly and enhance with time.In the presence of complement, they could destroy donor erythrocytes and cause hemolysis within 24 h to 72 h, resulting in ineffective transfusion.更多还原