中药联合血液净化早期干预治疗母婴血型不合新生儿溶血病  

Traditional Chinese medicine combined with plasma exchange for the treatment of HDN due to maternal-fetal ABO incompatibility

作　　者：马印图 陈莉[2] 贾桂丛[2] 董书文 张怡[1] 周景艳 杨晓亚 李莉华[2] MA Yintu;CHEN Li;JIA Guicong;DONG Shuwen;ZHANG Yi;ZHOU Jingyan;YANG Xiaoya;LI Lihua(Blood Transfusion Department,980 Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China;Hebei Blood Center)

机构地区：[1]中国人民解放军联勤保障部队第九八○医院,输血科,河北石家庄050082 [2]河北省血液中心

出　　处：《中国输血杂志》2021年第11期1209-1212,共4页Chinese Journal of Blood Transfusion

基　　金：河北省科技攻关计划课题(20170956)。

摘　　要：目的评价抗溶安胎中药联合血液净化技术干预治疗血型抗体高效价孕妇的有效性和安全性。方法 2018年5月~2021年4月期间来本院就诊的血型抗体高效价孕妇156例,其中ABO系统抗体效价≥512,Rh系统抗-D效价≥64的孕妇按自愿原则分成中药组(Ⅰ组)68例、中药+血液净化组(Ⅱ组)57例和对照组31例。对照组常规V;V;吸氧治疗;Ⅰ组在对照组的基础上服用抗溶安胎中药;Ⅱ组在Ⅰ组的基础上联合血浆去除治疗,每月治疗20 d,检测孕妇生化指标、血型抗体效价以及胎儿宫内发育情况,观察3种治疗方法的疗效、对孕妇的安全性以及产后新生儿溶血情况。结果Ⅰ组和Ⅱ组经过治疗后,血型抗体及IgG亚型效价下降时间和总有效率与对照组比较,P<0.05,对照组有效率18.52%(5/27),其中有4例改组而未做统计学分析,Ⅰ组72.59%(49/68)、Ⅱ组92.98%(53/57),治疗Ⅱ组产后新生儿未出现明显的溶血症状,疗效明显好于Ⅰ组和对照组。结论中药联合血液净化对早期干预治疗母婴血型不合新生儿溶血病效果明显,对孕妇和胎儿是安全的,值得临床推广应用。Objective To evaluate the efficacy and safety of early interventions by traditional Chinese medicine oral liquid combined with plasma exchange in the treatment of pregnant women with high titer of ABO/Rh antibodies.Methods 156 pregnant women with serum antibodies presenting high titer(ABO ≥512,Rh ≥ 64) in our hospital from May 2018 to April 2021 were randomly divided into traditional Chinese medicine group(group Ⅰ, n=68),traditional Chinese medicine combined with plasma exchange group(group Ⅱ, n=57) and control group(n=31).The control group were given V;,V;and oxygen uptake. Group Ⅰ were further given oral administration of traditional Chinese medicine liquid on the basis of treatment of the controls. GroupⅡwas further treated with plasma exchange on the basis of group I treatment(for 20 days every month). The biochemistry, serum antibody titer and foetus intrauterine growth were monitored. The the efficacy of treatment, as well as pregnancy and neonatal conditions in the three groups were observed. Results The decrease time of antibody titer and IgG subtype titer in groupⅠ and Ⅱ, relative to the controls, were significantly better(P<0.05). The effective rate of group Ⅰ(72.59%, 49/68) and group Ⅱ(92.98%,53/57) were significantly higher than the controls(18.52%, 5/27, with 4 cases excluded).No HDN occurred in group II, indicating superior treatment outcome to group I and the controls. Conclusion The oral administration of traditional Chinese medicine liquid combined with plasma exchange, with good therapeutic efficacy and maternal-fetal safety, was effective for the early interventions of ABO/Rh incompatible HDN and worthy of clinical application.

关 键 词：孕妇 血型抗体 抗体效价 中药 血液净化 新生儿溶血病 

分 类 号：R459.5[医药卫生—治疗学]