1300例新生儿溶血病血型血清学检测结果分析  

Analysis of blood group serological test results of 1 300 cases of newborns with hemolytic disease

作　　者：张钰 张璐[1] 许纪玲[1] 何晓露[1] 吕蕾 傅强[1] 何成涛[1] ZHANG Yu;ZHANG Lu;XU Jiling;HE Xiaolu;LV Lei;FU Qiang;HE Chengtao(Nanjing Red Cross Blood Center,Nanjing 210003,China)

机构地区：[1]南京红十字血液中心,江苏南京210003

出　　处：《中国输血杂志》2020年第9期922-924,共3页Chinese Journal of Blood Transfusion

摘　　要：目的分析和探讨血型血清学检测在新生儿溶血病(HDN)诊断中的应用。方法对2019年1月—2019年12月在本中心接受检测的1 300例疑似HDN的标本进行血型血清学检测,包括ABO、Rh血型鉴定、患儿血清学3项试验(直接抗球蛋白试验、血清游离抗体试验、红细胞抗体释放试验)、母亲血清IgG抗体效价检测。结果在1 300例检测结果中,确诊为HDN的有916例(70.46%),其中ABO血型不合者阳性率(95.85%)明显高于Rh血型不合者(3.39%)。O-A型母子血型模式的阳性率(94.78%)明显高于O-B型(82.6%),差异有统计学意义(P<0.01)。血清学3项试验发现,在确诊的916例HDN患儿中,直抗试验阳性为181例(19.76%),游离试验阳性为722例(78.82%),放散试验均为阳性(100%)。患儿标本采集时间>7d阳性检出率明显低于≤7d,差异有统计学意义(P<0.01)。随着母亲血清IgG抗体效价的增加,HDN检出率有增加的趋势(P<0.01)。结论母子血型不合导致HDN患儿中,ABO-HDN最为常见,O-A型母子血型模式发病率最高,血清学3项试验中放散抗体试验的敏感度最高,HDN阳性率与标本采集时间呈反比,而与母亲血清IgG抗体效价的高低呈正比。Objective To analyze and discuss the application of blood type serological test in the diagnosis of neonatal hemolytic disease(HDN). Methods 1 300 samples suspected as HDN throughout 2019 were sent to our center for blood group serology tests, including ABO,Rh blood group identification, three serological tests of infants(direct Coombs test, serum free antibody test, RBC antibody elution test), maternal serum IgG antibody titer test.Results Among the 1300 samples we received, 916(70.46%) cases were diagnosed as HDN, of which the incidence of ABO blood group incompatibility(95.85%) was significantly higher than that of Rh blood group incompatibility(3.39%). The incidence of O-A incompatibility(maternal type O and infant type A)(94.78%) was significantly higher than that of O-B incompatibility(82.6%), with significant differences between each other(P<0.01). Three serological tests found that among the 916 infants diagnosed as HDN, the direct Coombs test was positive in 181 cases(19.76%), free antibody test positive in 722 cases(78.82%), and elution antibody test positive in all(100%). The positive yield rate of samples collected >7 days was significantly lower than that≤7 days, and the difference was statistically significant(P<0.001). The incidence of HDN increased with the increment of maternal serum IgG antibody titer(P<0.001). Conclusion Among HDN caused by maternal-infant blood group incompatibility, ABO-HDN is the most common one, with O-A incompatibility exhibiting the highest incidence. Among the three serological tests, the sensitivity of elution antibody test is the highest.The yield rate of positive HDN test was proportional to the sampling time, and opposited to the titer of IgG antibody in maternal serum.

关 键 词：血型不合 新生儿溶血病 血型血清学检测 

分 类 号：R457.11[医药卫生—治疗学] R556.63[医药卫生—临床医学]