微柱凝胶法直接抗人球蛋白实验阳性强度的影响因素研究

Study of factors affecting the positive strength of direct antiglobulin test by microcolumn gel test

摘要:

目的 探讨患者直接抗球蛋白试验（direct antiglobulin test，DAT）阳性强度的关键影响因素，对临床DAT阳性患者在抗生素用药或红细胞输血时提供指导。方法 回顾性分析首都医科大学附属北京世纪坛医院2015年1月至2020年12月27 382例次行DAT检测的患者资料，对患者性别、年龄、临床诊断、抗生素使用、红细胞输注、DAT阳性强度等进行统计分析。结果 共有27 382人次患者进行了DAT检测，DAT阳性患者5 745人次（20.98%）。将不同DAT强度患者按男、女分组后做Mann-Whitney U检验，结果显示，男性DAT⁺强度高于女性，组间差异有统计学意义（U=2 764 704.5，P<0.001）。将DAT阳性患者按年龄分为3组（<18岁组、18~60岁组和>60岁组）后做Kruskal-Wallis检验。结果显示，不同年龄组间DAT阳性强度差异有统计学意义（H=200.4，P<0.001），<18岁组和>60岁组DAT 阳性强度高于18~60岁组。不同临床诊断之间分析结果显示DAT阳性强度差异有统计学意义（H=70.82，P<0.001）。Mann-Whitney U检验结果显示，使用抗生素和未使用抗生素组患者的DAT阳性强度分布不同，使用抗生素组患者DAT阳性强度更高（U=1 853 921.5，P<0.001）。红细胞输注组患者DAT阳性强度更高（U=3 315 953.5，P<0.001），但多次红细胞输注并未引起DAT阳性强度变化（U=108 911.5，P=0.68）。结论 在DAT阳性患者中，患者的性别、年龄、临床诊断、抗生素的应用、红细胞输注等均影响其DAT阳性强度，多次红细胞输注未见引起DAT⁺强度变化，临床上对DAT阳性强度较高的患者应谨慎使用抗生素及进行红细胞输注。

Abstract:

Objective To explore the key factors influencing the positive strength of direct antiglobulin test（DAT）in patients，and to provide guidance for clinical DAT-positive patients during antibiotic administration or red blood cell transfusion.Methods In the retrospective analysis of the data of 27 382 patients who underwent DAT from January 2015 to December 2020，we analyzed the patient's gender，age，clinical diagnosis，antibiotic usage，red blood cell transfusion，and DAT positive strength in statistics.Results A total of 27 382 patients underwent DAT，and 5 745（20.98%） were DAT-positive. Patients with different DAT strength were grouped by male and female，and Mann-Whitney U test was performed on them. The results showed that the DAT⁺ strength was significantly higher in the male than the female（U=2 764 704.5，P<0.001）. The DAT-positive patients were divided into 3 groups according to age（<18 years old group，18-60 years old group，>60 years old group）and the Kruskal-Wallis test results showed that the difference in DAT strength between different age groups was statistically significant（H=200.4，P<0.001）. The DAT positive strength of the <18 and >60 groups were higher than that of the 18–60 group. From the perspective of disease clinical diagnosis，the positive intensity of DAT was significantly different（H=70.82，P<0.001）. Mann-Whitney U analysis showed that the distribution of DAT strength was different between patients with or without usage of antibiotics，indicating that antibiotic usage increased DAT-positive strength（U=1 853 921.5，P<0.001）. DAT strength was higher in patients with red blood cell transfusion than in patients without red blood cell transfusion（U=3 315 953.5，P<0.001），but multiple red blood cell transfusions did not cause changes in DAT strength（U=108 911.5，P=0.68）.Conclusion In DAT-positive patients，the patient's gender，age，clinical diagnosis，antibiotic application，and red blood cell transfusion all affect their DAT strength. Repeated red blood cell transfusions haven't caused changes in DAT⁺ strength. Antibiotics and red blood cell transfusions should be used with caution in high DAT strength patients.