目的:红细胞免疫的发展加剧了地中海贫血患者的输血并发症。本文的目的是通过荟萃分析评估中国红细胞同种免疫患病率的现有证据。我们在Cochrane图书馆中系统地搜索了2000年至2021年5月在中国定期输血的地中海贫血患者的同种免疫的横断面研究,PubMed,EMBASE,WebofScience,以及包括CNKI在内的中文数据库,万方数据,Vip和CBM。对纳入研究进行数据提取和质量评价。使用DerSimonian和Laird随机效应模型进行荟萃分析,采用方差反加权。发表偏倚的存在是通过Egger的测试来测试的,每篇纳入的文章的方法学质量均通过针对患病率研究的标准进行评估.
结果:共有来自11项研究的1874名患者和263种同种抗体被鉴定并纳入荟萃分析。针对属于Rh的抗原的同种抗体的比例,MNSs和Kidd系统高达70.3%,17.9%,和6.5%,分别。Meta分析显示,中国输血依赖性地中海贫血患者的同种免疫总体患病率为11.4%(95CI:7.2%~16.3%)。
结论:中国常规输血的地中海贫血患者红细胞免疫的特点与其他国家有很大差异。因此,输血策略应积极适应中国的地中海贫血患者,以最大程度地降低同种免疫风险。
OBJECTIVE: The development of red blood cell
alloimmunization intensifies transfusion complication in thalassaemia patients. The purpose of this paper is to evaluate the existing evidence on the prevalence of erythrocyte
alloimmunization in China by meta-analysis. We systematically searched cross-sectional studies regarding the
alloimmunization of thalassaemia patients with regular blood transfusion in China from year 2000 to May 2021 in the Cochrane library, PubMed, EMBASE, Web of Science, and Chinese databases including CNKI, Wanfang Data, Vip and CBM. Data extraction and quality evaluation of the included studies were performed. Meta-analysis was performed using the DerSimonian and Laird random-effects models with inverse variance weighting. The presence of publication bias was tested by Egger\'s test, and the methodological quality of each included article was evaluated by the criteria specific to prevalence studies.
RESULTS: A total of 1874 patients and 263 alloantibodies from 11 studies were identified and included in the meta-analysis. The proportion of alloantibodies against antigens belonging to the Rh, MNSs and Kidd systems were as high as 70.3%, 17.9%, and 6.5%, respectively. Meta-analysis showed that the overall prevalence of
alloimmunization among transfusion-dependent thalassaemia patients in China is 11.4% (95%CI: 7.2%∼16.3%).
CONCLUSIONS: The characteristics of red blood cell
alloimmunization among thalassaemia patients with regular transfusion in China differ greatly from those in other countries. Therefore, transfusion strategies shall be actively adapted in line with thalassaemia patients in China to minimize the risk of alloimmunization.