53例Rh血型系统以外不规则抗体分布及新生儿溶血病发生关联分析  

Correlation between irregular antibody profiles of non-Rh blood group system and incidence of hemolytic disease of the newborn,53 cases

作　　者：乔静 刘庆生 庞新丰 高瑞光 郭步庆 王仁存 张欣 王爱玲 毕玲莉 QIAO Jing;LIU Qingsheng;PANG Xinfeng;GAO Ruiguang;GUO Buqing;WANG Rencun;ZHANG Xin;WANG Ailing;BI Lingli(Department of Pediatrics,Jiaozuo Maternal and Child Health Hospital,Jiaozuo 454000,China;Neonatology Department,Jiaozuo Maternal and Child Health Hospital,Jiaozuo 454000,China;Department of Blood Transfusion,Jiaozuo Maternal and Child Health Hospital,Jiaozuo 454000,China;Laboratory Department,Jiaozuo Maternal and Child Health Hospital,Jiaozuo 454000,China;Maternity Department,Jiaozuo Maternal and Child Health Hospital,Jiaozuo 454000,China;Department of Medical Genetics and Antenatal Diagnosis,Jiaozuo Maternal and Child Health Hospital,Jiaozuo 454000,China)

机构地区：[1]焦作市妇幼保健院儿科一区,河南焦作454000 [2]焦作市妇幼保健院新生儿科,河南焦作454000 [3]焦作市妇幼保健院输血科,河南焦作454000 [4]焦作市妇幼保健院检验科,河南焦作454000 [5]焦作市妇幼保健院产科,河南焦作454000 [6]焦作市妇幼保健院医学遗传与产前诊断科,河南焦作454000

出　　处：《中国输血杂志》2021年第8期874-877,共4页Chinese Journal of Blood Transfusion

基　　金：2019年河南省医学科技攻关计划联合共建项目(LHGJ20191368)。

摘　　要：目的回顾性分析53例孕产妇Rh血型系统外的6个血型系统不规则抗体情况,分析其与新生儿溶血病发生的关联。方法微住凝胶检测技术结合抗人球蛋白(IgG+C3d)对19473名孕产妇进行不规则抗体筛查,对不规则抗体筛查阳性标本进行不规则抗体确认试验,得出不规则抗体类型及不规则抗体效价;不规则抗体类型确定实验:巯基乙醇(2-Me)对不规则抗体阳性标本血清进行灭活后测定IgG型不规则抗体效价,对比2次不规则抗体效价水平进行IgG,IgM类型确定。分娩时采集脐血进行溶血3项试验及总胆红素检测分析黄疸水平及新生儿溶血病发生。结果19473名孕产妇检测出53例Rh血型系统以外不规则抗体,阳性比例为0.27%,以MNS血型系统,Lewis血型系统为主;新生儿溶血病(HDN)发生率39.6%(21/53),不规则抗体类型分布:单独IgM型27例,单独IgG型7例,IgM+IgG混合型19例。低效价组(≤8)与高效价组(>8)总胆红素检测对比:高效价组显著高于低效价组(P<0.05);IgG抗体亚型情况:高效价组IgG1明显增高(P<0.05),低效价组IgG3增高明显(P<0.05),IgG1,IgG3和总胆红素之间均存在显著的正相关关系;IgG1+IgG3联合诊断HDN的曲线下面积为0.953,敏感度0.900,特异度0.967。结论孕产妇Rh血型系统以外不规则抗体分布以MNS血型系统,Lewis血型系统为主;Kell,Duffy,kidd 3个血型系统产生不规则抗体后发生新生儿溶血病比例较高;不抗体类型多以单独IgM型或IgM+IgG混合型,发生新生儿溶血性的几率不高;高效价或低效价有不良孕产史患者早期可以分型IgG分型,IgG1,IgG3结果异常的应纳入高危产妇围产期管理,定期检测。Objective To retrospectively analyze the irregular antibodies in 6 blood group systems other than the Rh blood group system in 53 pregnant women and analyze its correlation with the occurrence of hemolytic disease of the newborn(HDN).Methods 19473 pregnant women were screened for irregular antibodies by microgel detection technology combined with anti-human globulin(IgG+C3d),and the positive samples screened out were further confirmed to understand the types and titers of irregular antibodies.Irregular antibody type determination experiment:IgG type irregular antibody titer was determined after mercaptoethanol(2-Me)inactivated the serum of the irregular antibody positive specimen,and then IgG and IgM type were determined by comparing the titer levels of irregular antibody.Three hemolysis tests and total bilirubin tests were performed on umbilical cord blood during delivery to analyze the level of jaundice and the occurrence of HDN.Results 53 cases of irregular antibodies other than the Rh blood group system were detected in 19473 pregnant women,with a positive rate of 0.27%,mainly MNS and Lewis blood group system.The incidence of HDN was 39.6%(21/53).There were 27 cases of IgM,7 IgG,and 19 IgM+IgG.Comparison of total bilirubin detection between the low titer group(≤8)and the high titer group(>8):the latter was significantly higher than the former(P<0.05);IgG antibody subtypes:IgG1 of the latter significantly increased(P<0.05),and so was IgG3 in former(P<0.05).There was a significant positive correlation between IgG1,IgG3 and total bilirubin.The area under the curve of IgG1+IgG3 for HDN diagnosis,the sensitivity and specificity were 0.953,0.900,and 0.967,respectively.Conclusion Other than Rh blood group system,irregular antibodies are mainly distributed in MNS and Lewis blood group system.The incidence of HDN is higher in Kell,Duffy and Kidd blood group systems after producing irregular antibodies.Non-antibody types are mostly IgM type or IgM+IgG mixed,and the incidence of HDN is not high;Patients with poor mate

关 键 词：非Rh血型系统 不规则抗体 新生儿溶血病 IGG抗体 

分 类 号：R457.1[医药卫生—治疗学] R722.18[医药卫生—临床医学]