母胎ABO血型不合孕妇抗体效价与围产儿溶血病的关系  

Relation between antibody titer in pregnant women with maternal-fetal ABO blood incompatibility and hemolytic disease of fetuses and newborns

作　　者：陈诚[1] 常青[1] 王延洲[1] 王琳[1] 周乐[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038

出　　处：《中华围产医学杂志》2013年第3期153-156,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨母胎ABO血型不合孕妇血型IgG抗体效价与围产儿溶血病的关系。方法2009年1月31日至2010年1月31日，在第三军医大学西南医院妇产科进行产前检查的母胎ABO血型不合的单胎妊娠孕妇共1269例。于妊娠28～30周取血清检测孕妇血型IgG抗体效价，分娩时取新生儿脐血查新生儿血型，并进行新生儿溶血病（hemolyticdiseaseofthenewborn，HDN）的血清学试验。回顾分析孕妇血清ABO血型IgG抗体效价及围产儿溶血病的发生情况，采用Kendall等级相关分析法分析孕妇血型抗体效价与围产儿溶血病之间的相关性。结果妊娠28～30周，58．4％（741／1269）的孕妇血清中未检测出ABO血型IgG抗体。5．1％（65／1269）的孕妇抗体滴度≥1：128，妊娠36周复查时，17例抗体效价倍增，但均未超过1：512，所有胎儿未发现水肿或胸腹腔积液等宫内溶血征象。380例新生儿诊断为HDN，占29．9％（380／1269）。其中12例新生儿出生24h内出现轻度贫血貌和（或）黄疸症状，占HDN患儿总数的3．2％（12／380）。随IgG抗体效价增加，HDN发生率增加，二者存在相关性（Tb=-0．293，P〈0．01）。当IgG抗体效价=1：128时，HDN发生率为85．4％（35／41），当IgG抗体效价=1：512时，HDN发生率为5／5，呈显著增加趋势（X2=108．906，P〈0．01）。380例新生儿中，322例转入本院新生儿重症监护病房接受以蓝光治疗为基础的综合治疗，其中2例行换血治疗，均痊愈出院。结论母胎ABO血型不合胎儿溶血发生率极低，妊娠期无需特殊处理；妊娠期进行AB0抗体效价检测，有利于及时诊断HDN并及时处理。Objective To investigate the relationship between IgG antibody titer in pregnant women with maternal-fetal ABO blood incompatibility and hemolytic disease of fetuses and newborns. Methods From January 31 2009 to January 31 2010, 1269 singleton pregnant women who were suspected to have maternal-fetal ABO blood incompatibility in Department of Obstetrics and Gynecology, Southwest Hospital, Third Military University were collected. Anti-A or anti-B IgG titers of them were detected at 28-30 gestational age, and umbilical cord blood were taken when delivery and hemolytic disease of the newborn serological test were done to diagnose hemolytic disease of the newborn （HDN）. The relationship between the titers and incidence of fetal or neonatal hemolytic disease was retrospectively analyzed by Kendall tau rank correlation. Results No IgG of anti-A or anti-B in serum were found in 58.4% （741/1269） pregnant women, while the antibody titer of 5.1% （65/1269） pregnant women were more than or equal to 1 ： 128. When they were tested again at 36 gestational week, the titer of 17 cases increased twice but lower than 1 ： 512. No signs of intrauterine hemolysis, such as edema, ascites and pleura1 effusion, were found. Three hundred and eighty neonates （29.9%, 380/1269） were diagnosed as HDN. Among which, 12 cases （3.2o//00, 12/380） showed mild anemia and （or） jaundice within 24 hours after delivery. There was positive correlation between incidence of neonatal hemolysis and antibody titer（Tb=-0. 293, P〈0.01）. The incidence of HDN increased from 85.4% （35/41） in women with antibody titer of 1 128 to 5/5 in women with antibody titer at 1 ： 512 （X2=108.906, P^0.01）. Among 380 HDN neonates, 322 cases were transferred to neonatal intensive care unit for phototherapy based comprehensive therapy, and two underwent exchange transfusion. All patients were cured. Conclusions The intrauterine hemolysis incidence of patients with suspected maternal-fetal ABO blood incompatibility is very low, and no s

关 键 词：ABO血型系统 血型不合 幼红细胞增多症 胎儿 孕妇 免疫球蛋白G 治疗结果 

分 类 号：R714.7[医药卫生—妇产科学]