Rh系统新生儿溶血病与IgG抗体亚类的相关性研究  

Study on the correlation of IgG antibody subclasses and the development of Rh-hemolytic disease of the newborn (Rh-HDN)

作　　者：侯玉涛[1] 童书青[2] 刘凯[3] 李超楠[1] 苗天红[3] 

机构地区：[1]北京安贞医院输血科,北京100000 [2]山东省立医院检验科 [3]北京市红十字血液中心血型室

出　　处：《中国输血杂志》2017年第4期366-368,共3页Chinese Journal of Blood Transfusion

摘　　要：目的探讨Rh系统新生儿溶血病(Rh-HDN)与IgG抗体亚类的相关性。方法对50例孕妇产前抗体鉴定为Rh系统同种抗体,患儿出生后抽静脉血做Rh血型、直接coombs试验、游离抗体试验、直抗IgG亚类检测,将抗-D存在时分为1组与其他抗体组比较血清胆红素值,将IgG1、3同时存时分为1组与IgG1或IgG3单独存在时比较血清胆红素值。结果 Rh血型系统5种抗原D、C、c、E、e的相应抗体均可以引起Rh-HDN,其中抗-D(34%)、抗-E(28%)是最常见的抗体,抗-D较其他Rh抗体引起的HDN严重。新生儿直接coombs试验≥2+,游离抗体试验W+-3+,直抗IgG亚类主要为IgG1(38%)或IgG1、3(48%),IgG1、3同时存在时较单种IgG引起的HDN严重,同时发现IgG2和IgG4也能通过胎盘,结合在红细胞上引起HDN。结论抗-D、抗-E是最常见的引起Rh-HDN的Rh抗体,抗-D引起的HDN较严重;引起HDN的IgG亚类主要为IgG1或IgG1、3,IgG1、3同时存在时引起的HDN较严重。Objective To investigate the correlation between Rh-hemolytic disease of the newborn （Rh-HDN） and IgG antibody subclasses.Methods First, 50 newborns whose mothers expressed isotype antibody in Rh system during pregnancy were selected. These newborns were phlebotomized and their Rh blood types were determined by direct Coombs test, free antibody test and DAT of anti-IgG subclasses. The experimental group consisted of the expression of anti-D, and was compared to a control group on the level of bilirubin. Meanwhile, the cases with IgG1 and IgG3 co-expression were clustered in the same group, and then were compared to IgG1 or IgG3 group on the level of bilirubin level, respectively.Results The antibodies against D, C, c, E, e antigens in Rh group system can cause Rh-HDN. Moreover, anti-D （34%） and anti-E （28%） constitute the most common ones, and anti-D caused a more severe form of HDN than other antibodies. Neonatal Direct Coombs test 2＋, free antibody test W＋-3＋, and DAT of anti-IgG subclass showed that the antibodies were mainly IgG1 （38%） or IgG1,3 （48%）. When IgG1 and IgG 3 coexisted, the symptoms of HDN were more severe than that caused by single IgG. IgG2 and IgG4 were found to pass through the placenta, and to induce HDN by binding red blood cells. Conclusion RhHDN was caused most commonly by anti-D and anti-E. The disease is more severe when induced by anti-D antibody. Meanwhile, IgG1 or IgG1,3 are determined to be the key factors related to the HDN. When IgG1 and IgG 3 appear simultaneously, the symptoms would appear more severe.

关 键 词：新生儿 RH血型 IGG亚类 溶血病 

分 类 号：R457.11[医药卫生—治疗学] R722.18[医药卫生—临床医学]