直接抗人球蛋白试验阳性在慢性重型乙型肝炎患者贫血中的临床意义

摘要

目的 探讨直接抗人球蛋白试验(DAT)阳性在慢性重型乙型肝炎患者贫血中的临床意义.方法 对30例健康人、30例慢性乙型肝炎(慢乙肝)患者和50例慢性重型乙型肝炎(慢重肝)患者红细胞相关参数及DAT进行检测,并对影响DAT阳性的临床相关因素进行分析.结果 慢重肝患者红细胞计数、血红蛋白(Hb)浓度以及红细胞压积(HCT)均低于慢乙肝患者和健康组(P<0.05),而慢重肝患者红细胞体积分布宽度(RDW)高于慢乙肝和健康组(P<0.05);慢重肝患者、慢乙肝患者和健康组DAT阳性率分别为62.82%、13.33%和0.DAT阳性的慢重肝患者红细胞计数、Hb浓度和HCT均低于相应DAT阴性患者(均P<0.05),RDW却高于DAT阴性慢重肝患者(P=0.001);慢重肝患者红细胞毛细管分离后,衰老红细胞的DAT阳性强度高于年轻红细胞DAT阳性强度(P<0.001);在慢重肝患者中,DAT的阳性和阴性的患者在性别、年龄、丙氨酸氨基转移酶、总胆红素、补体C3、C-反应蛋白及是否并发糖尿病方面存在差异(均P≤0.05).结论 慢重肝患者贫血的产生可能与衰老红细胞吸附抗体所致的免疫性溶血有关.%Objective To evaluate clinical significance of direct antiglobulin testing(DAT)in anemia in patients with severe chronic hepatitis B(CHB).Methods Red blood cell(RBC)-related parameters detection and DAT were performed among 30 healthy persons,30 CHB patients,and 50 severe CHB patients,clinical factors related to posi-tive DAT were analyzed.Results RBC count,hemoglobin (Hb)concentration,and hematocrit(HCT)level in severe CHB patients were all lower than CHB patients and healthy group(P <0.05),RBC distribution width(RDW)in severe CHB patients were all higher than CHB patients and healthy group(P<0.05);the positive rate of DAT in patients with se-vere CHB,CHB,and healthy group were 62.82%,13.33% and 0 respectively.RBC count,Hb concentration,and HCT level in severe CHB patients with positive DAT were all lower than severe CHB patients with negative DAT (all P <0.05),while RDW was higher than the latter (P=0.001);after RBC was separated through capillary,positive intensity of DAT of aged RBCs was higher than young RBCs in severe CHB patients (P <0.001);among severe CHB patients, DAT-positive and-negative patients differed in gender,age,alanine aminotransferase,total bilirubin,complement C3, C-reactive protein,and complication of diabetes(all P≤0.05).Conclusion Anemia in severe CHB patients may be re-lated to immune hemolysis of aged RBCs induced by antibody adsorption.