| Objective To explore the distribution proportion of human leucocyte antigen(HLA)and human platelet antigen(HPA)genotypes in the population,and investigate the effect of platelet matching transfusion based on HLA and HPA genotypes on platelet transfusion refractory(PTR)patients.It is expected that the platelet level of PTR patients can be effectively improved under the condition of blood resource shortage.Methods 30 patients with ineffective platelet transfusion caused by immune factors in Zibo Central Hospital were selected to test the antibody properties and make statistics.And two hundred unrelated platelet donors were randomly selected from the central blood station of Zibo City,and 5m L of EDTA anticoagulant blood was collected respectively.After DNA extraction,HLA-A,HLA-B and hpa1-17 were genotyped and gene frequencies were systematically analyzed by pcr-sequence-based typing(PCR-SBT)and pcr-sequence specific primer(PCR-SSP),and the differences of gene distribution between Zibo and other populations were compared by statistical analysis.At the same time,the 30 PTR patients were divided into three groups: the Same Blood Group(BG),the Cross-Matched(CM)group and the Same Genotype(SG)group.The BG group chose the same ABO blood type random transfusion mode for platelet transfusion,the CM group chose the platelet with negative cross matching type for platelet transfusion,the SG group chose the same genotype platelet matching mode for platelet transfusion.The peripheral blood platelet count and the number of platelet transfusion were measured 1 h before and 24 h after transfusion,and then the corrected count increment(CCI)was calculated to observe the effect of infusion,and the difference between groups was statistically significant(P< 0.05).Result(1)HLA-I antibody,HPA antibody and platelet autoantibody were detected in the serum of PTR patient.The positive patients of HLA-I antibody was 18,and the positive rate was 60%.The positive rate of HPA antibody was 12,and the positive rate was 40%.The positive rate of autoantibody was 2,and the positive rate was 6.6%.(2)A total of 15 HLA-A alleles and 29 HLA-B alleles were detected respectively.The top five gene frequencies were A*02,A*24,A*11,A*30,A*33,with a gene frequency in 0.260 0,0.172 5,0.137 5,0.135 0,0.070 0,respectively.For the HLA-B locus,the top five gene frequencies were B* 13,B* 15,B* 40,B*44,B* 51,with a gene frequency of 0.160 0,0.132 5,0.130 0,0.067 5,0.062 5,respectively.(3)Monomorphic HPA 4a,7a-14 a,16a,17 a were found in the samples,but none of corresponding allele antigen HPA-b was detected.In HPA1-17,the heterozygosity of HPA15 system is the highest.The genotypes of HPA15a/15 a,HPA15a/15 b and HPA15b/15 b are 0.275,0.530 and 0.195,respectively.The second level of heterozygosity is HPA3 system.The genotypes are HPA3a/3a,HPA3a/3b and HPA3b/3b,and their frequencies are 0.345,0.500 and 0.155,respectively.(4)The difference of HLA-A and HLA-B alleles frequency between Zibo and Guangdong,northern Han,Ningxia Hui and Manchu is statistically significant(P<0.05),there was no significant difference compared with Linyi area in Shandong Province(P>0.05).The difference of HPA gene frequency between Zibo and Shanghai,Chongqing,Taiwan,Britain and black America is statistically significant(P<0.05),the difference is not statistically significant compared with Weifang Area(P>0.05).(5)In the clinical experiment,the CCI of the BG group is-1.53±2.06,the CCI of the CM group is 1.65±1.29 and the CCI of the SG group is 7.95±2.14.Compared with the BG group,the difference of the other two groups is statistically significant(P<0.05).And the the difference between the CM group and the SG group is statistically significant(P< 0.05).Conclusion(1)For the PTR patients in Zibo area,the main platelet autoantibody is anti-HLA antibody,followed by anti-HPA antibody,and only a few patients have platelet autoantibody.(2)By exploring the distribution characteristics of HLA-A,HLA-B and HPA 1-17,and comparing the gene frequency among different regions,it is indicated that the HLA and HPA gene distribution of platelet donors in Zibo region have regional characteristics,and it is necessary to establish HLA and HPA platelet donor database in Zibo.(3)For patients with ineffective platelet transfusion caused by immune factors,platelet transfusion with the same genotype platelet matching method is more effective than platelet cross matching phased platelet transfusion and random transfusion with the same blood type,which is more conducive to the treatment of patients and can effectively save blood resources. |
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