孕期效价变化的连续监测及ABO新生儿溶血病发病各因素的相关性研究  

Correlation study between continuous monitoring of antibody titre during gestation and ABO hemolytic disease of the newborn

作　　者：袁咏梅[1] 刘和录[1] 何亚[1] 陈望[1] 林洁[1] 余素燕[1] 李娴[1] 

机构地区：[1]广州医学院附属深圳沙井医院,广东深圳518104

出　　处：《中国输血杂志》2014年第3期291-293,共3页Chinese Journal of Blood Transfusion

摘　　要：目的观察0型孕妇产前及孕期IgG抗-A(B)效价水平变化,分析其与ABO新生儿溶血病发生的相关性;同时通过对产下的新生儿进行跟踪调查,研究各项指标与ABO新生儿溶血病的关联。方法采用抗球蛋白检测卡初检夫妻血型不合的O型孕妇IgG抗-A(B)效价,并对其中初检效价≥64的孕妇跟踪其孕期血型抗体效价变化情况(初检约在25孕周左右,复检在初检后约1月1次效价检测直至生产),产下的新生儿取静脉血进行5项试验:ABO血型、Rh血型、直接抗球蛋白试验、游离试验、热放散试验。结果初检1 563份血清中IgG抗-A(B)效价≥64者846例,异常检出率为54.13%(846/1 563);其中A型丈夫效价≥64检出423例,异常检出率为51.84%(423/816);B型丈夫效价≥64检出319例,异常检出率为55.96%(319/570);AB型丈夫效价≥64检出104例,异常检出率为58.76%(104/177)。初检结果与HDN相关性分别为:效价≥64组为14.89%,≥128组为59.72%。末次效价与HDN生成相关性分别为:效价≥64组为30.80%,≥128组为67.02%。末/初效价比≤1∶1组、2∶1组、4∶1组、8∶1组分别为770、55、19、2例,实验室诊断HDN阳性分别为66、36、18、2例,有黄疸、贫血分别为48、32、18、2例。跟踪846例孕妇所产新生儿中,A型、B型、O型分别417、328、101例,确诊HDN 126例,其中A型、B型、O型分别为82、43、1例。结论丈夫A、B、AB血型间相对HDN发生率差异无统计学意义。末次效价比初检效价更能有效的反应HDN的生成。末/初效价比值越大产生HDN的几率就越大,且临床症状出现黄疸、贫血就越重。确诊HDN 126例中新生儿性别分布差异无统计学意义。A、B、O血型分布差异有统计学意义,A型明显多于其他2种血型。Objective To observe the changes of the IgG-A（B） antibody concentration in pregnant women with the O group blood,and analyze it relationship with ABO hemolytic disease of newborn （ABO HDN）. The relationship between vari-ous indicators and ABO HDN was also studied through the follow-up survey of newborn. Methods The Coombs test cards were used to screen for the pregnant women with O group blood whose couples blood types were incompatible. Then their IgG-A（B） antibody concentration was detected. For the pregnant women （titers ≥ 64 ）, the maternal antibody was dynamically monitored（ The initial examination was conducted at the 25 gestational weeks. After that ,the reinspedion was conducted once a month till the childbirth）. The red blood cells taken from vein of newborn were used to detect the five parameters： ABO blood types,Rh blood types ,direct antiglobulin test ,free antibodies test ,Thermal elution test. Results There were 846 cases with maternal antibody titer higher than 1：64 in 1 563 cases,the abnormal rate was 54. 13% ,including 423 cases with mater-nal antibody titer higher than 1 ： 64 in A group blood husbands （ the abnormal rate was 51.84% ）, 319 cases with maternal an-tibody titer higher than 1：64 with B group blood husbands （the abnormal rate was 55.96% ） , and 104 cases with maternal antibody with AB group blood husbands （ the abnormal rate was 58.76% ）. Tile association of initial inspection results with HDN were 14. 89% （ titer≥ 1： 64 ） and 59. 72% （ titer ≥1 1 ： 128 ）, respectively. Last inspection results and HDN were 30. 80% （ titer ≥1 ： 64） and 67. 02% （ titer≥ 1 ： 128 ）. There were 770,55,19,2 cases at the ratio of end and beginning titer less than 1 ： 1,2： 1 ,4：1 and 8：1 group, respectively. The positives of HDN were 66,36,18 and 2 eases, respectively,in whicb the positives of jaundice and anemia were 48,32,18 and 2 cases. The A ,B ,O group blood were 417 328 and 101cases from 846 newborns （ 126 cases with HDN

关 键 词：连续监测 IgG抗-A(B) ABO新生儿溶血病 

分 类 号：R457.11[医药卫生—治疗学] R221.8[医药卫生—临床医学]