【摘要】 目的 在造血干细胞移植前的血液病患者中，探究抗人类白细胞抗原(human leucocyte antigen, HLA)抗体产生的危险因素。方法 收集2016-2018年间本院1 008名血液病患者在移植前采用Luminex技术平台进行抗HLA抗体检测的结果及临床数据，并对其进行统计学分析。结果 1 008名患者的抗HLA抗体总体阳性率为24.08%。多因素分析显示，与抗HLA抗体产生相关的独立危险因素包括年龄≥30岁(P=0.046,OR 1.467,95%CI 1.007-2.136)、疾病确诊至抗体检测的时间≥41d(P=0.000,OR 1.830,95%CI 1.306-2.565)、初诊PLT计数<20×10~9/L(P=0.020,OR 1.543,95%CI 1.072-2.220)、有妊娠史(P=0.000,OR 5.187,95%CI 3.689-7.293)、入院前有输血史(P=0.001,OR 1.762,95%CI 1.257-2.470)和入院后PLT输注总量≥30U(P=0.000,OR 2.352,95%CI 1.638-3.376)。其中年龄≥30岁(P=0.023,OR=1.839,95%CI 1.088-3.108)、妊娠史(P=0.042,OR=5.258,95%CI 1.062-26.038)分别与抗HLA-Ⅰ类、Ⅱ类抗体的产生有关；疾病确诊至抗体检测时间≥41d(P=0.000,OR=2.873,95%CI 1.612-5.119)、初诊PLT计数<20×10~9/L(P=0.008,OR=2.164,95%CI 1.225-3.822)、妊娠史(P=0.002,OR=6.734,95%CI 1.993-22.751)、入院前的输血史(P=0.001,OR=2.746,95%CI 1.531-4.925)、入院后PLT输注>30U(P=0.006,OR=3.459,95%CI 1.416-8.451)与抗HLA-Ⅰ+Ⅱ类抗体的产生有关。结论 年龄较大、病程较长、PLT计数较低、有妊娠史和输血史、PLT输注总量较多，均是影响抗HLA抗体产生的危险因素。因此，对移植前血液病患者宜根据情况检测抗HLA抗体，这对于指导供者选择、监测抗体变化和改善移植预后具有重要价值。更多还原

【Abstract】 Objective To explore the risk factors for the production of anti-HLA antibodies in patients with hematological diseases before hematopoietic stemcell transplantation. Methods The results and clinical data of 1 008 patients with hematological diseases in our hospital who underwent anti-HLA antibody testing were collected by using Luminex technology platform before transplantation from 2016 to 2018 for statistical analysis. Results The total positive rate of anti-HLA antibodies in 1 008 patients was 24.08%. Multivariate analysis showed that independent risk factors associated with the production of anti-HLA antibodies included age≥30 years old(P=0.046,OR1.467,95%CI1.007-2.136), time from disease diagnosis to antibody testing≥41 days(P=0.000,OR1.830,95%CI1.306-2.565), initial platelet count<20×10~9/L(P=0.020,OR1.543,95%CI1.072-2.220),prior pregnancy(P=0.000,OR5.187,95%CI3.689-7.293),transfusions before admission(P=0.001,OR1.762,95%CI1.257-2.470)and total platelet transfusion volumes after admission≥30 U(P=0.000,OR2.352,95%CI1.638-3.376). Age ≥30 years old(P=0.023,OR=1.839,95%CI1.088-3.108)and prior pregnancy(P=0.042,OR=5.258,95%CI1.062-26.038)are associated with the production of anti-HLA class Ⅰ and class Ⅱ antibodies, respectively. The time from disease diagnosis to antibody testing≥41 days(P=0.000,OR=2.873,95%CI1.612-5.119),initial platelet count<20×10~9/L(P=0.008,OR=2.164,95%CI1.225-3.822),prior pregnancy(P=0.002,OR=6.734,95%CI1.993-22.751),transfusions before admission(P=0.001,OR=2.746,95%CI1.531-4.925)and total platelet transfusion volumes after admission>30 U(P=0.006,OR=3.459,95%CI1.416-8.451)are associated with the production of anti-HLA class Ⅰ and Ⅱ antibodies. Conclusion Older age, longer course of disease, lower PLT count, history of pregnancy and blood transfusion, and higher total amount of PLT transfusion are risk factors which affect the production of anti-HLA antibodies.Therefore, it is advisable to test for anti-HLA antibodies according to the situation before transplantation, which is of great value in guiding donor selection, monitoring antibody changes and improving transplant prognosis.更多还原