魏秀萍

【摘要】 目的：探讨骨髓增生异常综合征（MDS）患者反复输注血小板的输血效果，并分析影响血小板输注无效（PTR）的因素。方法：选取2019年1月—2022年12月潍坊市中医院收治的63例MDS患者为此次研究对象。依据PTR判定标准[输血后24 h校正血小板增高指数值（CCI）≤4、血小板回升率（PPR）≤20%]评估入组对象输血效果，logistic回归分析影响MDS患者PTR的因素。结果：入组63例MDS患者中，34例（53.97%）输注有效，29例（46.03%）输注无效。有效组与无效组在血小板抗体阳性、发热、脾肿大、P-选择素、人抗凝血酶3抗体水平比较上差异均有统计学意义（P<0.05），在性别、年龄、体重指数（BMI）、病程、WHO分型、国际预后评分（IPSS-R）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）比较，差异均无统计学意义（P>0.05）。单因素logistic分析结果显示，上述有统计学差异的指标均为影响MDS患者PTR的相关因素（P<0.05）。多因素logistic回归分析结果显示，血小板抗体阳性、P-选择素、人抗凝血酶3抗体升高均为影响MDS患者PTR的危险因素（OR=1.855、1.927、1.984，P<0.05）。结论：MDS患者反复输注血小板的输血效果不甚理想，PTR主要与血小板抗体阳性、P-选择素和人抗凝血酶3抗体水平有关。

【关键词】 骨髓增生异常综合征 血小板输注无效 危险因素 血小板抗体

Analysis of the Effect and Influencing Factors of Repeated Platelet Transfusion in MDS Patients/WEI Xiuping. //Medical Innovation of China， 2024， 21（15）： 153-157

[Abstract] Objective： To explore blood transfusion effect of repeated platelet transfusion in patients with myelodysplastic syndrome （MDS）， and to analyze the influencing factors of platelet transfusion refractoriness （PTR）. Method： Sixty-three patients with MDS admitted to Weifang Hospital of Traditional Chinese Medicine from January 2019 to December 2022 were selected as the study objects. According to PTR criteria （CCI ≤4 at 24 h after blood transfusion， PPR ≤20%）， blood transfusion effect was evaluated. The influencing factors of PTR in MDS patients were analyzed by logistic regression analysis. Result： Among the 63 patients with MDS， there were 34 cases （53.97%） with effective transfusion and 29 cases （46.03%） with ineffective transfusion. There were significant differences in platelet antibody positive， fever， splenomegaly， P-selectin and human antithrombin 3 antibody between effective group and ineffective group （P<0.05）， but there were no differences in gender， age， BMI， course of disease， WHO classifications， IPSS-R， prothrombin time （PT） or activated partial thromboplastin time （APTT） between the two groups （P>0.05）. The results of univariate logistic analysis showed that the above indexes with statistical differences were all related influencing factors of PTR in MDS patients （P<0.05）. The results of multivariate logistic regression analysis showed that platelet antibody positive， increased P-selectin and human antithrombin 3 antibody were all influencing factors of PTR in MDS patients （OR=1.855， 1.927， 1.984， P<0.05）. Conclusion： The blood transfusion effect of repeated platelet transfusion is not satisfactory in MDS patients. PTR is mainly related to platelet antibody positive， P-selectin and human antithrombin 3 antibody.

[Key words] Myelodysplastic syndrome Platelet transfusion refractoriness Risk factor Platelet antibody

First-author's address： Department of Blood Transfusion， Weifang Hospital of Traditional Chinese Medicine， Weifang 261041， China

doi：10.3969/j.issn.1674-4985.2024.15.036

骨髓增生异常综合征（myelodysplastic syndromes，MDS）是一种克隆性疾病，以骨髓造血细胞恶性增殖及分化异常相关，且有较高风险出现白血病转化。对于多数MDS患者而言，进行性骨髓衰竭是其临床表现，且以急性髓细胞白血病为最终发展趋势[1-2]。关于MDS病因的探讨当前尚不明确，多认为与电离辐射，强电磁场，使用细胞毒类化疗药物等因素有关。当前主张以强化疗法和造血干细胞移植手段进行治疗，但强化疗法后血小板减少引起的致病性出血可能造成患者死亡[3-4]。在此期间患者可出现头晕、乏力及心悸等一系列表现，需要及时进行血小板输注方可改善出血倾向。随着血小板输注的广泛应用，许多患者在反复输注血小板后难以达到止血目的而呈现血小板输注无效（PTR）状态[5-6]。……