标题：急性白血病患者HPA-1~6，15基因多态性与血小板输注疗效的相关性研究

      作者：苗 菁，曾小菁
    （贵阳医学院附属医院血液科，贵州 贵阳 550004）

      卷次： 2014年25卷3期

      【摘要】 目的 通过检测人类血小板抗原 1~6,15系统(Human platelet alloantigen，HPA-1~6, 15)，探讨HPA
多态性与血小板输注疗效的相关性。方法 (1)收集30例输注2次以上血小板的急性白血病患者外周血标本，根
据血小板回收率（Percentage platelet recovery，PPR)判定输注效果；(2)采用酚/氯仿方法提取DNA；(3)采用聚合酶
链反应-序列特异性引物（Polymerase chain reaction-sequence specific primers，PCR-SSP）方法在相同条件下对血
小板抗原HPA-1~6,15进行基因分型，分析HPA抗原与血小板输注疗效的关系。结果 (1) HPA-1~3、HPA-5~6、
HPA-15系统等位基因呈多态性分布；HPA-4呈 aa纯合子单态性分布，HPA-1、5、6基因以 aa纯合子为主，仅
HPA-3、15见 bb纯合子，b等位基因频率以HPA-2最高(0.65)，其次依次为HPA-15 (0.349)，HPA-3 (0.3)。(2) 30
例急性白血病患者中有21例血小板输注无效，无效率为70%，多集中于输注3次及以上组。结论 (1)抗-HPA引
起血小板输注无效概率较小，主要发生在HPA-2、3、15系统，对需作HPA配型的患者只要针对此3个系统进行检
测，就可提高输注效果。(2)临床应注重血小板输注治疗的个体化，减少输注次数，提高输注疗效。

      【关键词】 血小板输注；疗效；急性白血病；血小板特异抗原；基因多态性

      【中图分类号】 R733.71 【文献标识码】 A 【文章编号】 1003—6350（2014）03—0313—05


Correlation between polymorphism of HPA-1~6,15 and the effect of platelet transfusion in patients with acute
leukemia.
MIAO Jing, ZENG Xiao-jing. Department of Hematology, the Affiliated Hospital of Guiyang Medical College,
Guiyang 550004, Guizhou, CHINA

【Abstract】 Objective To study the correlation between polymorphism of Human platelet antigens (HPA)
and the effect of platelet transfusion, through testing the gene of the HPA-1~6,15. Methods (1) The peripheral blood
simples of 30 patients with acute leukemia who had accepted platelet transfusion for two or more times were collected.
The effect of platelet transfusion was evaluated by percentage platelet recovery (PPR). (2) The method of phonelic/
chloroform was applied to extract DNA. (3) PCR with sequence specific primers (PCR-SSP) was used to type HPA1~
6,15 under the same conditions. The curative effect of platelet transfusion was observed. Results (1) The system al-
leles of HPA-1~3, HPA-5~6, HPA-15 showed polymorphism distribution; HPA-1, 5, 6 mainly showed aa homozy-
gous genotype, HPA-4 presented homozygous single-state distribution, only HPA-3, 15 presented bb homozygous gen-
otype; HPA-2 had the highest heterozygous level (0.65), followed by HPA-15 (0.349), HPA-3 (0.3). (2) Platelet trans-
fusion refractoriness (PTR) was found in 21 of the 30 patients of acute leukemia, with the rate of inefficiency of 70%,
mainly concentrated in the patients undergoing 3 or more times of platelet transfusion. Conclusion (1) A few case of
PTR is caused by anti-HPA, and testing HPA-2, 3, 15 genes maybe enough to improve the effect of platelet transfu-
sion for patients of HPA matching. (2) Patients individualization should be taken into consideration in clinical practice,
in order to reduce the chance of repeated transfusion and increase the effective rate.

      【Key words】 Platelet transfusion; Effect; Acute leukemia; Human platelet antigens (HPA); Polymorhism