中国输血杂志2025，Vol.38Issue(12)：1687-1694,8.DOI:10.13303/j.cjbt.issn.1004-549x.2025.12.006
探讨高HLA抗体异基因造血干细胞移植患者移植前不同脱敏治疗的护理特点和处理措施
Exploring the nursing characteristics and management for patients with high levels of human leukocyte antigen(HLA)-antibodies undergoing different desensitization strategies before allogeneic hematopoietic stem cell trans-plantation(allo-HSCT)
摘要
Abstract
Objective To investigate the efficacy,nursing characteristics,and management of different desensitization strategies before allogeneic hematopoietic stem cell transplantation(allo-HSCT)among patients with high level of human leukocyte antigen(HLA)antibodies.Methods A retrospective analysis was conducted on 82 patients with high levels of HLA antibodies who underwent allo-HSCT at the First Affiliated Hospital of Soochow University and Suzhou Hopes Hema-tonosis Hospital between January 2020 to November 2023.Patients were divided into two groups based on the desensitization strategy they received:the anti-CD20 monoclonal antibody combined with therapeutic plasma exchange(TPE)group(n=50)and the anti-CD20 monoclonal antibody combined with Protein A immunoabsorption group(n=32).The differences of efficacy between the desensitization strategies were analyzed.The safety of both desensitization strategies were assessed by close monitoring of adverse events throughout the treatment.The nursing characteristics and interventions specific to these strategies were comprehensively summarized.Results There were no significant differences in age,gender,and diagnosis between the two groups of patients receiving different desensitization strategies(P＞0.05).Following desensitization in the immunoadsorption group,the mean fluorescence intensity(MFI)levels of anti-HLA Class Ⅰ antibody decreased significantly compared to initial screening(P=0.048),while the decrease in MFI values of anti-HLA Class Ⅱ antibody was not statisti-cally significant(P=0.173).In the TPE group,the MFI levels for both anti-HLA Class Ⅰ and Ⅱ antibodies after desensiti-zation decreased significantly compared to initial screening(P=0.025 and 0.028,respectively).Monitoring of adverse e-vents during desensitization treatment,found that patients in the immunoadsorption group experienced mild decreases in blood pressure during the process,with two patients developing severe hypotension.No allergic reactions occurred,and no damage of liver or kidney function was observed after the immunoadsorption.In the immunoadsorption group,a total of 19 patients underwent sera immunoglobulin assays before and after immunoadsorption.Compared to the initial screening,the immunoglobulin G(IgG)levels significantly decreased after immunoadsorption(P＜0.001).In TPE group,12 patients ex-perienced mild hypotension during the plasma exchange process,but no severe hypotension was observed.One patient de-veloped an allergic reaction.After the TPE treatment,no damage of liver or kidney function was observed,nor any decrease of IgG levels.In terms of safety of intravenous access,neither group experienced severe complications such as catheter-relat-ed bloodstream infections or deep vein thrombosis.In the TPE group,catheter occlusion occurred during the process of plas-ma exchange in 2 patients,while no such incident was observed in the immunoadsorption group.Patients of both groups ex-hibited anxiety and depression before treatment.After psychological care,the scores for anxiety and depression significantly decreased(P＜0.001).Conclusion Both desensitization strategies significantly decreased the HLA antibodies in highly sensitized patients with high level of HLA antibodies undergoing allo-HSCT.For patients receiving immunoabsorption,nurs-ing care should focus on preventing and managing hypotension and implementing infection-prevention measures due to IgG depletion.In contrast,for those undergoing TPE,vigilant monitoring and prompt management of potential allergic reactions are essential components of nursing practice.关键词
高HLA抗体/异基因造血干细胞移植/免疫吸附/血浆置换/护理Key words
high level of HLA antibody/allogeneic stem cell transplantation/immunoadsorption/therapeutic plasma exchange/nursing分类
医药卫生引用本文复制引用
ZHOU Danping,GU Yanting,LU Yin,ZHANG Cuiping,ZHOU Shiyuan,ZHOU Xiaohong,ZHU Xiaming..探讨高HLA抗体异基因造血干细胞移植患者移植前不同脱敏治疗的护理特点和处理措施[J].中国输血杂志,2025,38(12):1687-1694,8.基金项目
苏州市基础试点项目(SSD2024030) （SSD2024030）
