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目的研究主要ABO血型不合异基因造血干细胞移植(allo-HSCT)后患者纯红细胞再生障碍(PRCA)的发病情况及危险因素。方法分析移植后患者PRCA的发病危险因素,比较抗A凝集素与抗B凝集素对红系造血恢复的影响。结果100例ABO血型主要及主次要均不合allo-HSCT患者中,12例发生PRCA。A供O者9例,A供B者1例,B供O者2例。有抗A凝集素的患者(10例)较有抗B凝集素的患者(2例)易发生PRCA(P<0.05)。PRCA的发生不影响急性移植物抗宿主病(GVHD)或巨细胞病毒(CMV)感染的发生。发生PRCA时血型转换的中位时间为150.5d,显著长于无PRCA发生患者(60.0d)(P<0.05);红系恢复的中位时间为203.5d,显著长于无PRCA发生患者(76.0d)(P<0.05)。有抗A凝集素的患者血型转换中位时间为90.0d,显著长于有抗B凝集素的患者(55.0d)(P<0.05);红系恢复中位时间为98.0d,长于有抗B凝集素者(80.0d)(P>0.05),但差异无统计学意义。结论PRCA是ABO血型不合移植的合并症之一。A供O是主要ABO血型不合allo-HSCT后PRCA发病的危险因素。
Objective To investigate the incidence and risk factors of pure erythrocyte aplasia (PRCA) in patients with major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The risk factors of PRCA in patients after transplantation were analyzed, and the effect of anti-lectin and anti-B lectin on erythrocyte hematopoiesis recovery was compared. Results Among 100 cases of ABO blood group, 12 cases had PRCA in primary and secondary and primary none in allo-HSCT. A for O in 9 cases, A for B in 1 case, B for O in 2 cases. Patients with anti-A lectin (10 patients) were more prone to PRCA than those with anti-B lectin (2 patients) (P <0.05). The occurrence of PRCA does not affect the occurrence of acute graft-versus-host disease (GVHD) or cytomegalovirus (CMV) infection. The median time to blood group conversion at PRCA was 150.5 days, significantly longer than that of patients without PRCA at 60.0 days (P <0.05). The median time to erythroid recovery was 203.5 days, significantly longer than that of patients without PRCA (76.0 days) (P <0.05). Patients with anti-A lectin had a median blood group transition of 90.0 days, significantly longer than patients with anti-B lectin (55.0 days) (P <0.05); median recovery time of erythroid was 98.0 days longer than those with anti-B agglutination (80.0d) (P> 0.05), but the difference was not statistically significant. Conclusion PRCA is one of the complications of ABO incompatible transplantation. A for O is a major risk factor for the onset of PRCA after the major ABO blood group is not allo-HSCT.