严重贫血患者输注异体红细胞制品发生输血相关肺损伤与制品储存时间的相关性分析-东南大学学报医学版

严重贫血患者输注异体红细胞制品发生输血相关肺损伤与制品储存时间的相关性分析

单位：湖北文理学院附属医院, 襄阳市中心医院输血科, 湖北襄阳 441021

分类号：R556;R563.8;R457.13

出版年·卷·期（页码）：2021·40·第三期（341-346）

摘要：

目的：探讨异体红细胞输注时储存时间与严重贫血患者输血相关急性肺损伤（TRALI）发生的相关性。方法：回顾性分析2016年1月至2019年12月于我院确诊重度贫血并使用异体血液制品治疗的379例患者资料，收集患者一般资料、实验室检查资料及输注的去白细胞红细胞悬液储存相关信息。而后按照患者是否发生TRALI进行分组，并采用Logistic回归分析去白细胞红细胞悬液储存时间与TRALI发生的相关性，而后通过建立ROC曲线分析相关因素对TRALI的预测价值。结果：两组患者一般资料比较差异无统计学意义（P>0.05）。TRALI组IL-6、IL-1β及TNF-α水平显著高于非TRALI组（P<0.001）。TRALI组去白细胞红细胞悬液输注总量及储存时间显著多于非TRALI组（P<0.05）。TNF-α（OR为1.042，95%CI为1.008~1.077）、输注总量（OR为2.201，95%CI为1.339~3.619）及储存时间（OR为1.069，95%CI为1.011~1.132）与TRALI发生呈正相关（P<0.05）。TNF-α、输注总量、储存时间及联合检测（串联）对患者TRALI发生具有较好的预测作用（P<0.05）。联合检测灵敏度显著高于其他3种检测方式（P<0.05），而特异度与其他3种方式比较差异无统计学意义（P>0.05）。结论：异体红细胞制品输注时储存时间与严重贫血患者TRALI发生显著相关，TNF-α、输注总量及储存时间的综合预测模型对于患者TRALI具有较好的预测价值。

Objective: To investigate the correlation between the storage time of allogeneic red blood cell transfusion and the occurrence of blood transfusion-related acute lung injury(TRALI) in patients with severe anemia. Methods: The data of 379 patients who were diagnosed with severe anemia and treated with allogeneic blood products in our hospital from January 2016 to December 2019 were retrospectively analyzed. The patients' general information, laboratory examination data and storage related information of the leukocyte-removed red and white blood cells suspension were collected. Then, the patients were grouped according to whether the patients had TRALI, and Logistic regression was used to analyze the correlation between the storage time of leukocyte-removed red and white blood cells suspension and the occurrence of TRALI. Results: There was no significant difference in general information between the two groups (P>0.05). The levels of IL-6, IL-1β and TNF-α in TRALI group were significantly higher than those in non-TRALI group (P<0.001). The total infusion and storage time of leukocyte-depleted red and white blood cells suspension in TRALI group were significantly higher than those in non-TRALI group (P<0.05). TNF-α(OR:1.042,95%CI:1.008-1.077), total infusion (OR:2.201,95%CI:1.339-3.619)and storage time(OR:1.069,95%CI:1.011-1.132) were positively correlated with the occurrence of TRALI (P<0.05). TNF-α, total infusion, storage time and combined detection (tandem) had a good predictive effect on the occurrence of TRALI in patients (P<0.05). The combined detection sensitivity was significantly higher than the other three detection methods (P<0.05), while the specificity was not significantly different from the other three methods (P>0.05).Conclusion: The storage time of allogeneic red blood cell products during infusion is significantly related to the occurrence of TRALI in patients with severe anemia. The establishment of a comprehensive predictive model of TNF-α, total infusion and storage time has a good predictive value for TRALI in patients.

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