IgG抗体效价及亚型对母婴ABO血型不合新生儿溶血病的诊断价值  

The diagnostic value of IgG antibody titers and subtypes in the diagnosis of hemolytic disease of newborns caused by maternal and infant ABO blood type incompatibility

作　　者：梁振国 范贞 庞新丰 原艺睿 孙宁宁 刘庆生 王建红 LIANG Zhenguo;FAN Zhen;PANG Xinfeng;YUAN Yirui;SUN Ningning;LIU Qingsheng;WANG Jianhong(Department of Blood Transfusion,Xincai County People's Hospital,Zhumadian,Henan 463500,China;Department of Blood Transfusion,Maternal and Child Health Hospital of Jiaozuo City,Jiaozuo,Henan 454000,China;Department of Neonatology,Maternal and Child Health Hospital of Jiaozuo City,Jiaozuo,Henan 454000,China;Department of Medical Genetics and Prenatal Diagnosis,Maternal and Child Health Hospital of Jiaozuo City,Jiaozuo,Henan 454000,China)

机构地区：[1]河南省驻马店市新蔡县人民医院输血科,河南驻马店463500 [2]河南省焦作市妇幼保健院输血科,河南焦作454000 [3]河南省焦作市妇幼保健院新生儿科,河南焦作454000 [4]河南省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：《检验医学与临床》2022年第2期175-178,共4页Laboratory Medicine and Clinic

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191368)。

摘　　要：目的探讨IgG抗体效价及亚型对母婴ABO血型不合新生儿溶血病(HDN)的诊断价值。方法选取2019年1月至2020年6月河南省驻马店市新蔡县人民医院收治的298例高胆红素血症患儿及其母亲作为研究对象。采用微柱凝胶法检测298例患儿及其母亲的ABO血型;采用抗人球蛋白法检测新生儿溶血三项、母亲不规则抗体;采用巯基乙醇试验检测患儿母亲的血清ABO血型系统IgG抗体效价;采用酶联免疫吸附试验检测患儿母亲ABO血型系统IgG抗体亚型(IgG1、IgG2、IgG3、IgG4)。结果纳入的298例高胆红素血症患儿中,母婴ABO血型不合143例(47.99%),HDN患儿115例(38.59%)。143例母婴ABO血型不合患儿中,早产儿HDN的发生率为91.26%,足月儿HDN的发生率为52.50%,差异有统计学意义(P<0.05);第2胎HDN的发生率为91.03%,第1胎HDN的发生率为67.69%,差异有统计学意义(P<0.05)。受试者工作特征曲线分析结果显示,IgG抗体效价从143例母婴ABO血型不合患儿中诊断出HDN的曲线下面积(AUC)为0.957,灵敏度为0.832,特异度为0.964,截断值为1∶64。IgG1、IgG3联合检测诊断HDN的AUC为0.953,灵敏度为0.903,特异度为0.957,高于两项单独检测。IgG抗体低效价组IgG1水平低于高效价组,IgG3水平高于高效价组,差异有统计学意义(P<0.05)。结论母婴ABO血型不合导致的HDN发生率高,可通过检测孕产妇ABO血型IgG抗体效价及亚型来预测HDN的发生,指导临床治疗。Objective To explore the diagnostic value of IgG antibody titers and subtypes in the diagnosis of hemolytic disease of newborns(HDN) caused by maternal and infant ABO blood type incompatibility.Methods A total of 298 children with hyperbilirubinemia and their mothers admitted to Xincai County People′s Hospital from January 2019 to June 2020 were selected as the research objects.Used microcolumn gel method to detect the ABO blood type of 298 children and their mothers.Used anti-human globulin method to detect three items of hemolysis in newborns and irregular antibodies in mothers.Used mercaptoethanol test to detect the serum ABO blood type system IgG antibody titer of the mothers.Used enzyme-linked immunosorbent assay to detect the ABO blood type system IgG antibody subtypes(IgG1,IgG2,IgG3,IgG4) of the mothers.Results Among the included 298 children with hyperbilirubinemia, 143 cases(47.99%) with maternal and infant ABO blood type incompatibility, 115 cases(38.59%) of children with HDN.Among the 143 cases of maternal and infant ABO blood type incompatibility, the incidence of HDN in preterm infants was 91.26%,and the incidence of HDN in term infants was 52.50%,the difference was statistically significant(P<0.05).The incidence of HDN in the second fetus was 91.03%,and the incidence of HDN in the first fetus was 67.69%,the difference was statistically significant(P<0.05).The results of receiver operating characteristic curve analysis showed that the area under the curve(AUC) for the diagnosis of HDN in 143 cases of maternal and infant ABO blood type incompatibility with IgG antibody titer was 0.957,the sensitivity was 0.832,the specificity was 0.964,and the cut-off value was 1∶64.The AUC of the combined detection of IgG1 and IgG3 in the diagnosis of HDN was 0.953,the sensitivity was 0.903,and the specificity was 0.957,which was higher than the two separate detect.The IgG1 level in IgG antibody low titer group was lower than the high titer group, and the IgG3 level was higher than the high titer group, the diffe

关 键 词：IGG抗体 新生儿溶血病 ABO血型 

分 类 号：R722.18[医药卫生—儿科]