JAMA:接受有怀孕史的女性血液后,男性死亡风险增加了……
2017/10/19
近日,发表于JAMA上的一项研究发现,男性输血者接受有怀孕史的女性血液,死亡风险增加。


在50岁以下的男性中,输血后的3年里,死亡风险增大,并且最可能的死因是一种名为输血相关急性肺损伤的不良免疫反应。在去年,JAMA子刊就曾发表过一篇献血者性别年龄与接受者死亡风险之间联系的文章。研究发现,接受年轻女性献血的受血者死亡率增加。

在这项新研究中,莱顿大学医学中心的研究人员分析了2005年至2015年间在荷兰接受59,320次输血的31,118名患者的信息。献血者有三种类型:男性、从未怀孕的女性和怀过孕的女性。他们分别占了献血总人数的88%、6%和6%。患者死亡率为13%,共计3939人。统计发现,死亡患者中占比最大的是那些接受有怀孕史的女性血液的男性。

研究人员表示:“在接受过红细胞输血的患者中,与男性献血者相比,接受怀过孕的女性供者的血液与男性接受者的全因死亡率升高有关,而女性接受者却没有受到影响。此外,从未怀孕的女性献血者的血液与男性或女性接受者死亡率的增加无关。”

从怀孕的献血者那里接受血液的男性的死亡比率是每1000人死亡101人,而男性捐赠者对应的死亡人数为80人,未怀孕的捐赠者为78人。

虽然这项研究显示了一些相关性,但却不能解释为何曾经怀孕的女性血液会遗留这样的效果。研究人员猜想,这可能与怀孕期间免疫发生变化有关。

在该论文的一篇相关评论中,来自瑞典卡罗林斯卡医学院的两位医生表示研究人员的下一步重点将是研究潜在的机制。“这些结果极具轰动性,如果是真的,将会具有重大的临床意义。但是,其他的研究却报告了相互矛盾的结果,这类研究的方法也十分复杂。因此,应该考虑对所这种关联性做出其他解释。”

参考资料:

Blood Transfusions From Some Women Can Be More Dangerous For Men, Says Study

Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients

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  • Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients

    Importance Transfusion of red blood cells from female donors has been associated with increased mortality in male recipients. Objective To quantify the association between red blood cell transfusion from female donors with and without a history of pregnancy and mortality of red blood cell recipients. Design, Setting, and Participants Retrospective cohort study of first-time transfusion recipients at 6 major Dutch hospitals enrolled from May 30, 2005, to September 1, 2015; the final follow-up date was September 1, 2015. The primary analysis was the no-donor-mixture cohort (ie, either all red blood cell transfusions exclusively from male donors, or all exclusively from female donors without a history of pregnancy, or all exclusively from female donors with a history of pregnancy). The association between mortality and exposure to transfusions from ever-pregnant or never-pregnant female donors was analyzed using life tables and time-varying Cox proportional hazards models. Exposures Red blood cell transfusions from ever-pregnant or never-pregnant female donors, compared with red blood cell transfusions from male donors. Main Outcomes and Measures All-cause mortality during follow-up. Results The cohort for the primary analyses consisted of 31 118 patients (median age, 65 [interquartile range, 42-77] years; 52% female) who received 59 320 red blood cell transfusions exclusively from 1 of 3 types of donors (88% male; 6% ever-pregnant female; and 6% never-pregnant female). The number of deaths in this cohort was 3969 (13% mortality). For male recipients of red blood cell transfusions, all-cause mortality rates after a red blood cell transfusion from an ever-pregnant female donor vs male donor were 101 vs 80 deaths per 1000 person-years (time-dependent “per transfusion” hazard ratio [HR] for death, 1.13 [95% CI, 1.01-1.26]). For receipt of transfusion from a never-pregnant female donor vs male donor, mortality rates were 78 vs 80 deaths per 1000 person-years (HR, 0.93 [95% CI, 0.81-1.06]). Among female recipients of red blood cell transfusions, mortality rates for an ever-pregnant female donor vs male donor were 74 vs 62 per 1000 person-years (HR, 0.99 [95% CI, 0.87 to 1.13]); for a never-pregnant female donor vs male donor, mortality rates were 74 vs 62 per 1000 person-years (HR, 1.01 [95% CI, 0.88-1.15]). Conclusions and Relevance Among patients who received red blood cell transfusions, receipt of a transfusion from an ever-pregnant female donor, compared with a male donor, was associated with increased all-cause mortality among male recipients but not among female recipients. Transfusions from never-pregnant female donors were not associated with increased mortality among male or female recipients. Further research is needed to replicate these findings, determine their clinical significance, and identify the underlying mechanism.

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