Rh系新生儿溶血病患病种类变迁及管理策略研究  

Change of types of neonatal Rh hemolytic disease and research of management strategy

作　　者：黄晨艳[1,2] 沈敏祥[1,3] 刘辉[1,2] 董娟[1,2] 方向东[1,2] 黄大雁[1,2] 吕晓燕[1,2] 丁琴[1,2] 杨善发[1,4] 

机构地区：[1]安徽医科大学卫生管理学院卫生管理系,安徽合肥230022 [2]安徽省合肥市妇幼保健院检验科 [3]安徽省卫生厅妇幼处 [4]安徽医科大学卫生管理学院

出　　处：《中国妇幼保健》2011年第34期5287-5290,共4页Maternal and Child Health Care of China

摘　　要：目的:统计近20年因母婴Rh系血型不合引起新生儿溶血病(HDN)种类的变迁,为预防和避免人类输血反应,降低母婴新生儿溶血病患病率、死亡率,提出行政管理策略和建议。方法:1991年12月1日～2010年7月31日期间产前免疫血液学检测江淮地区汉族18 050对夫妇的ABO血型、RH(D)血型,筛选和鉴定稀有血型抗体,跟踪随访Rh(D)阴性与Rh(E)阴性母亲所分娩的新生儿溶血病患病率。结果:①1991年12月1日～1999年12月31日期间共检查了6 085对夫妇,共发现41例Rh(D)阴性,其中孕妇中发现25例Rh(D)阴性,丈夫16例Rh(D)阴性,共鉴定出Rh系新生儿溶血病6例,其中仅1例Rh(E)新生儿溶血,5例Rh(D)新生儿溶血,实施换血疗法均成功。②2000年1月1日～2010年7月31日产前免疫检测11 965对夫妇,共发现78例Rh(D)阴性,其中孕妇中发现有41例Rh(D)阴性,丈夫37例Rh(D)阴性;共鉴定出Rh-HDN8例(共7胎),发现4例Rh(E)新生儿溶血;实施蓝光治疗和输注免疫球蛋白等治疗方案均成功。③统计Rh(D)阴性占0.337%,Rh-HDN患病率20世纪为0.986‰,21世纪为0.669‰,Rh(E)阴性母亲所产的Rh系新生儿溶血病的患病率比例由原来的16.670%上升为≥50.000%。结论:①Rh-HDN是可预防和治疗的,产前免疫血液学检查起到早诊断、早治疗作用。②Rh-HDN的溶血性与母体IgG血型抗体效价呈正相关。③20世纪与21世纪江淮地区汉族Rh系新生儿溶血病患病率最高由IgG抗D变为IgG抗E。④Rh(E)溶血病均因产前延误诊断或忽视检测而造成,Rh(E)溶血病发病率跃居第一位。⑤该项研究涉及每个学科,且危及人的生命,故提出相关卫生管理策略和法律建议。Objective：To understand the change of types of neonatal hemolytic disease induced by maternal-fetal Rh blood group incompatibility,put forward administrative management strategy and suggestion to prevent and reduce human blood transfusion reactions,reduce the prevalence and mortality of neonates with hemolytic disease.Methods：18 050 couples of Han nationality were selected from Jianghuai area from December first,1991 to July 31st,2010,then prenatal immunoserological test was conducted to detect their ABO blood types and RH（D） blood types,the antibodies of rare blood types were screened and identified,the prevalence of neonates with hemolytic disease who were born by the mothers with negative Rh（D） and Rh（E） was followed up.Results：①6 085 couples were examined totally from December first,1991 to December 31st,1999,41 cases were found with negative Rh（D）,including 25 pregnant women and 16 husbands,6 neonates were found with hemolytic disease,including one neonate with Rh（E） hemolytic disease and 5 neonates with Rh（D） hemolytic disease,all the neonates were cured successfully by exchange transfusion.②11 965 couples received immunodetection from January first,2000 to July 31st,2010,78 cases were found with negative Rh（D）,including 41 pregnant women and 37 husbands,8 cases（7 fetuses） were found with neonatal Rh hemolytic disease,4 neonates were found with neonatal hemolytic disease;all the cases were cured successfully by phototherapy（blue light） and transfusion of immunoglobulin.③The proportion of cases with negative Rh（D） was 0.337%,the incidences of neonatal Rh hemolytic disease in the twentieth century and the twenty-first century were 0.986 ‰ and 0.669 ‰,respectively,the incidence of neonatal Rh hemolytic disease who were born by the mothers with negative Rh（E） increased from 16.670% to ≥50.000%.Conclusion：①Neonatal Rh hemolytic disease can be prevented and treated,prenatal immunoserological test is of value for early diagnosis and early treatment.

关 键 词：Rh系新生儿溶血病 患病率 种类变迁 行政管理 法律建议 

分 类 号：R722.18[医药卫生—儿科]