86例直接抗人球蛋白试验阳性病例分析
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摘要
目的调查分析直接抗人球蛋白试验(DAT)阳性患者的病种分布特征及不同病种的抗体和补体类型,并探讨DAT阳性的影响因素及临床意义。方法采用经典试管法对608例患者标本进行DAT初步筛查,DAT阳性标本做进一步抗体和补体分型,分析患者临床资料。结果 608例患者标本主要来自风湿免疫科、血液内科、产科及其他内科。其中检出DAT阳性86例,阳性率为14.14%。86例DAT阳性患者的疾病类型主要为系统性红斑狼疮(SLE)占26.74%,自身免疫性溶血性贫血(AIHA)占18.60%,其他血液病占15.11%,干燥综合征占13.95%,新生儿溶血病占5.81%。DAT阳性患者标本分型结果显示,IgG+C3d类型阳性率最高,占61.73%,其次为单独IgG型和单独C3d型,阳性率分别为19.75%和18.52%。结论对DAT阳性结果应结合临床背景进行分析,并进行抗体类型的检定,以辅助临床诊断和治疗。
Objective To investigate the distribution of direct antiglobulin test(DAT) positive in hospitalized patients and interpret DAT positive results and its clinical significance. Methods DAT was performed with test tube method by using polyspecific reagents that can simultaneously detect IgG and complement. Subsequently, the positive samples were distinguished by monospecific reagents for specific types of antibodies and complements. Results Total 86 cases were identified as DAT positive in 608 cases(positive rate 14.14%),which mainly from department of rheumatology, hematology, obstetrics and other internal medicine. Among 86 DAT positive cases, patients with systemic lupus erythematosus(SLE) took up the highest proportion of 26.74%, followed by autoimmune hemolytic anemia(AIHA) of 18.60%, other blood disease of 15.11%, Sjogren syndrome of13.95%, and hemolytic disease of newborn(HDN) of 5.81%. Based on the type of antibody and complement, DAT positive samples were classified as IgG+C3 d, accounting for 61.73%, IgG for 19.75%, and C3 d for 18.52%. Conclusion DAT results should be best interpreted in the context of clinical situations and further to distinguish types of antibody and complement, which is helpful for clinical diagnosis and therapy.
Objective To investigate the distribution of direct antiglobulin test(DAT) positive in hospitalized patients and interpret DAT positive results and its clinical significance. Methods DAT was performed with test tube method by using polyspecific reagents that can simultaneously detect IgG and complement. Subsequently, the positive samples were distinguished by monospecific reagents for specific types of antibodies and complements. Results Total 86 cases were identified as DAT positive in 608 cases(positive rate 14.14%),which mainly from department of rheumatology, hematology, obstetrics and other internal medicine. Among 86 DAT positive cases, patients with systemic lupus erythematosus(SLE) took up the highest proportion of 26.74%, followed by autoimmune hemolytic anemia(AIHA) of 18.60%, other blood disease of 15.11%, Sjogren syndrome of13.95%, and hemolytic disease of newborn(HDN) of 5.81%. Based on the type of antibody and complement, DAT positive samples were classified as IgG+C3 d, accounting for 61.73%, IgG for 19.75%, and C3 d for 18.52%. Conclusion DAT results should be best interpreted in the context of clinical situations and further to distinguish types of antibody and complement, which is helpful for clinical diagnosis and therapy.
引文
[1]胡丽华.临床输血学检验[M].3版.北京:人民卫生出版社,2012,48.
[2] Rottenberg Y, Yahalom V, Shinar E, et al. Blood do-nors with positive direct antiglobulin tests are atincreased risk for cancer[J]. Transfusion, 2009, 49(5):838-842.
[3] Ricci F, Tedeschi A, Vismara E, et al. Should a posi-tive direct antiglobulin test be considered a prog-nostic predictor in chronic lymphocytic leukemia[J].Clin Lymphoma Myeloma Leuk, 2013,13(4):441-446.
[4] Agarwal A, Medical Student SB, Lim-Stavros S, et al.Pediatric systemic lupus erythematosus presentingwith coronary arteritis:A case series and review ofthe literature[J]. Semin Arthritis Rheum, 2015, 45(1):42-47.
[5]梁洁玲,黄美群,王发雄,等.抗人球蛋白试验阳性患者分布特征探讨[J].国际检验医学杂志,2012,33(17):2161-2162.
[6] Zantek ND, Koepsell SA, Tharp DR Jr, et al. The di-rect antiglobulin test:a critical step in the evalu-ation of hemolysis[J]. Am J Hematol, 2012,87(7):707-709.
[7]王桂菊.系统性红斑狼疮相关性血液病血液学异常临床特点[J].中国实验血液学杂志,2002,10(4):416-419.
[8]张松青,赵静,刘捷.系统性红斑狼疮65例血液学异常临床意义分析[J].中国皮肤性病学杂志,2009,23(9):573-574.
[9]阳福桂,刘芳,戚志萍,等.直接抗人球蛋白试验在临床贫血及输血患者中的应用[J].临床输血与检验,2015,17(6):498-500.
[10] Chaudhary RK, Das SS. Autoimmune hemolytic anemia:from lab to bedside[J]. Asian J Transfus Sci, 2014,8(1):5-12.
[11]李勇,马学严.实用血液免疫学血型理论和实验技术[M].北京:科学出版社,2006:458-465,596-597.
[12] Dacie SJ. The immune haemolytic anaemias:a centuryof exciting progress in understanding[J]. Br J Hae-matol, 2001,114(4):770-785.
[13] Wright MS, Smith LA. Laboratory investigation of au-toimmune hemolytic anemian[J]. Clin Lab Sci, 1999,12(2):119-125.
[14]姚文.交叉配血及安全输血的探讨[J].检验医学与临床,2010,7(22):2532.
[15]曹丛雪,刘景东.直接抗人球蛋白试验阳性贫血患者输血前疑难配血处理及血液成分的选择[J].检验医学与临床,2011,8(24):3032-3033.
[16]戴小波,任燕歌,曾朱燕,等.直接抗人球蛋白试验阳性非自身免疫性溶血性贫血患者的临床特征和输血对策[J].中国输血杂志,2013,26(6):555-557.
[2] Rottenberg Y, Yahalom V, Shinar E, et al. Blood do-nors with positive direct antiglobulin tests are atincreased risk for cancer[J]. Transfusion, 2009, 49(5):838-842.
[3] Ricci F, Tedeschi A, Vismara E, et al. Should a posi-tive direct antiglobulin test be considered a prog-nostic predictor in chronic lymphocytic leukemia[J].Clin Lymphoma Myeloma Leuk, 2013,13(4):441-446.
[4] Agarwal A, Medical Student SB, Lim-Stavros S, et al.Pediatric systemic lupus erythematosus presentingwith coronary arteritis:A case series and review ofthe literature[J]. Semin Arthritis Rheum, 2015, 45(1):42-47.
[5]梁洁玲,黄美群,王发雄,等.抗人球蛋白试验阳性患者分布特征探讨[J].国际检验医学杂志,2012,33(17):2161-2162.
[6] Zantek ND, Koepsell SA, Tharp DR Jr, et al. The di-rect antiglobulin test:a critical step in the evalu-ation of hemolysis[J]. Am J Hematol, 2012,87(7):707-709.
[7]王桂菊.系统性红斑狼疮相关性血液病血液学异常临床特点[J].中国实验血液学杂志,2002,10(4):416-419.
[8]张松青,赵静,刘捷.系统性红斑狼疮65例血液学异常临床意义分析[J].中国皮肤性病学杂志,2009,23(9):573-574.
[9]阳福桂,刘芳,戚志萍,等.直接抗人球蛋白试验在临床贫血及输血患者中的应用[J].临床输血与检验,2015,17(6):498-500.
[10] Chaudhary RK, Das SS. Autoimmune hemolytic anemia:from lab to bedside[J]. Asian J Transfus Sci, 2014,8(1):5-12.
[11]李勇,马学严.实用血液免疫学血型理论和实验技术[M].北京:科学出版社,2006:458-465,596-597.
[12] Dacie SJ. The immune haemolytic anaemias:a centuryof exciting progress in understanding[J]. Br J Hae-matol, 2001,114(4):770-785.
[13] Wright MS, Smith LA. Laboratory investigation of au-toimmune hemolytic anemian[J]. Clin Lab Sci, 1999,12(2):119-125.
[14]姚文.交叉配血及安全输血的探讨[J].检验医学与临床,2010,7(22):2532.
[15]曹丛雪,刘景东.直接抗人球蛋白试验阳性贫血患者输血前疑难配血处理及血液成分的选择[J].检验医学与临床,2011,8(24):3032-3033.
[16]戴小波,任燕歌,曾朱燕,等.直接抗人球蛋白试验阳性非自身免疫性溶血性贫血患者的临床特征和输血对策[J].中国输血杂志,2013,26(6):555-557.