血清学指标及溶血三项试验对新生儿溶血病早期诊断的价值  

Value of serological indicators and three tests of hemolysis on the early diagnosis of neonatal hemolysis

作　　者：薛松 徐诗雅 孙会丽 XUE Song;XU Shiya;SUN Huili(Department of Blood Transfusion,Fuyang Hospital,Anhui Medical University,Fuyang,Anhui,China,236000)

机构地区：[1]安徽医科大学附属阜阳医院输血科,安徽阜阳236000

出　　处：《分子诊断与治疗杂志》2022年第2期312-316,共5页Journal of Molecular Diagnostics and Therapy

基　　金：安徽省公益性研究联动计划项目(15011d04060)。

摘　　要：目的探究溶血三项试验和血清总胆红素、血红蛋白(Hb)、网织红细胞百分比(Ret%)检测对新生儿溶血病(HDN)早期诊断的价值。方法选取2017年7月至2021年7月安徽医科大学附属阜阳医院新生儿科收治的疑似新生儿溶血病患儿256例的样本,均进行红细胞系统血型抗体致新生儿溶血病检测,并检测其血清总胆红素、Hb及Ret%含量,分析溶血三项试验和血清总胆红素检测对新生儿溶血病早期诊断的价值。结果256例送检标本中,HDN阳性77例,阳性率为30.08%。直抗试验A-HDN阳性的发生率高于B-HDN(P<0.05),ABO-HDN患儿中游离试验及放散试验阳性结果差异无统计学意义(P>0.05)。另统计中发现Rh(D)母婴血型不合4例,直抗试验和放散试验结果均为阳性,并最终都确诊为新生儿Rh-HDN。77例HDN患儿直抗试验阳性40.26%,游离试验阳性96.10%,放散试验阳性为100%;游离试验与放散试验同为阳性占58.44%,直抗试验与放散试验同为阳性占2.60%,放散试验阳性者1.3%,阳性率比较组合2>组合1>组合3>组合4。ROC曲线显示,血清总胆红素、Hb及Ret%预测HDN阳性的AUC分别为0.762、0.809、0.836。结论抗体放散试验对HDN的敏感度最高,ABO血型不合者血型A-HDN的发生率要高于血型B;且联合血清学指标检测利于HDN的早期诊断及治疗。Objective To explore the value of the three hemolysis tests and serum total bilirubin,hemoglobin(Hb),reticulocyte percentage(Ret%)testing for the early diagnosis of neonatal hemolysis(HDN).Methods Samples from 256 children with suspected hemolytic disease of the newborn who were admitted to the Department of Neonatology,Fuyang Hospital Affiliated to Anhui Medical University from July2017 to July 2021 were all tested for hemolytic disease of the newborn caused by blood group antibodies of the erythrocyte system,and their serum levels were detected.Contents of bilirubin,Hb and Ret%,analysis of the value of three hemolytic tests and detection of serum total bilirubin in the early diagnosis of hemolytic disease of the newborn.Results Among the 256 samples submitted,77 were HDN positive,with a positive rate of30.08%.The incidence of A-HDN positive in direct antibody test was higher than that of B-HDN(P<0.05).There was no significant difference in the positive results of free test and emission test among children with ABO-HDN(P>0.05).In addition,4 cases of Rh(D)maternal and infant blood group incompatibility were found in the statistics,and the results of direct resistance test and emission test were positive,and all of them were finally diagnosed as neonatal Rh-HDN.40.26%of the 77 children with HDN were positive in the direct resistance test,96.10%in the free test,and 100%in the emission test;58.44%were both positive in the free test and the emission test,2.60%were both positive in the direct resistance test and the emission test,1.3%were positive in the emission test,and the positive rate was compared to combination 2>combination 1>combination 3>combination 4.The ROC curve showed that the AUCs of serum total bilirubin,Hb and Ret%for predicting HDN positivity were 0.762,0.809 and 0.836,respectively.Conclusion Antibody release test has the highest sensitivity to HDN,the incidence of A-HDN in ABO incompatibility than B;and combined serological test is conducive to the early diagnosis and treatment of HDNined detection o

关 键 词：新生儿溶血病 直接抗人球蛋白试验 游离试验 放散试验 总胆红素 

分 类 号：R722.18[医药卫生—儿科]