新生儿MN血型不合溶血病3例报道暨文献复习  

Hemolytic disease of the newborn caused by anti-M: three recent case reports and literature review of other cases

作　　者：边巴卓玛[1,2] 夏斌[1] 伍金林[1] 熊英[1] 母得志[1] 

机构地区：[1]四川大学华西第二医院儿科 出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [2]西藏那曲地区人民医院儿科

出　　处：《中国新生儿科杂志》2014年第1期22-26,共5页Chinese Journal of Neonatology

基　　金：国家自然科学基金项目(81370738);国家自然科学基金重点项目(81330016);国家临床重点专科建设项目(1311200003303);生殖遗传教育部重点实验室(浙江大学)开放基金资助项目(2012-RG/ND-0002)

摘　　要：目的总结新生儿MN血型不合溶血病的临床特点、诊治经验及发病机理。方法报告我科近年诊治的3例新生儿MN血型不合溶血病,复习我科曾报道的另外2例,并通过中国知网、万方数据库和维普中文期刊数据库,检索国内近24年来报告的所有病例报告,对患儿的临床表现和实验室检查进行总结分析。结果包括本文报道的3例,国内共报道31例新生儿MN血型不合溶血病,MN型25例,M型6例;直接抗人球蛋白试验阳性13例,抗体释放试验阳性17例,患儿血型抗体IgG抗M型阳性28例;母亲血型抗体IgG抗M型阳性30例,IgM抗M阳性16例。31例患儿中6例(19.4%)为第1胎发病,贫血发生率67.7%,其中重度贫血发生率29.0%,重度高胆红素血症发生率22.6%;较多患儿需要换血(29.0%)和输血(45.2%);病死率9.7%。结论新生儿MN血型不合溶血病容易出现黄疸、贫血,可导致患儿急性死亡。光疗、输注丙种球蛋白、白蛋白等治疗效果良好,严重病例需要换血、输血治疗。为了提高MN溶血病的诊断率,应检测孕妇MN血型及抗M抗体效价。Objective To review the clinical manifestations, diagnosis and treatments of hemolytic disease of the newborn （HDN） due to anti-M. Methods In order to summarise the clinical features of HDN and relevant diagnostic tests, data was collected including 5 cases of HDN due to anti-M from our ward （ including 2 cases reported previously） as well as eases recorded in the CNKI, Wan Fang, and Wei Pu clinical databases. Results There were 26 cases of HDN due to anti M collected from the clinical databases, which covered almost all the published Chinese literature for the past 24- years. Of the 31 cases, 25 had MN blood group, 6 had M blood group, 13 had positive direct antiglobin, 17 had positive antibody release test, IgG anti M was positive in 28 infants. There were 30 mothers who were positive for IgG anti M and 16 mothers were positive for lgM anti M. 19.4% of mothers were G1P1, there was high incidence of anemia （severe anemia was 29.03% with total anemia 67.7% ）, The incidence of severe hyperbilirubinemia was 22.6% , 29.0% patients needed exchange transfusion, and 45.2% needed blood transfusion, 3 infants （9.7%） died. Conclusions HDN due to anti-M can cause severe pathological jaundice and anemia in newborn infants. Phototherapy, intravenous infusions of IVIG and albumin are routine treatments, severe cases needed exchange transfusion and/or blood transfusion. Detection of MN blood type and the concentration of anti M of pregnant mothers will improve diagnosis of HDN due to anti-M.

关 键 词：溶血症 新生儿 血型不合 抗M抗体 

分 类 号：R722.1[医药卫生—儿科]