71例Rh血型同种抗体孕妇的妊娠结局分析  

Pregnancy outcome with Rh blood group alloantibody: analysis of 71 pregnant women

作　　者：郭煜[1] 冯大文 钟惠英 汤颖思 张伟轩 耿文艳[2] GUO Yu;FENG Dawen;ZHONG Huiying;TANG Yingsi;ZHANG Weixuan;GENG Wenyan(Department of Blood Transfusion,The First Affiliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,China;Department of Blood Transfusion,The Third Affiliated Hospital of Guangzhou Medical University)

机构地区：[1]广东药科大学附属第一医院输血科,广东广州510080 [2]广州医科大学附属第三医院输血科

出　　处：《中国输血杂志》2022年第5期520-523,共4页Chinese Journal of Blood Transfusion

摘　　要：目的 回顾性调查本地区两家医院含有Rh同种抗体孕妇的抗体分布及其妊娠结局,总结Rh同种抗体导致新生儿溶血病的患病率、诊治经验,为Rh-新生儿溶血病(HDN)的预防、诊断及治疗提供资料。方法 选取2014年1月~2020年12月17 345例本地区两家医院就诊的孕妇进行不规则抗体筛查试验,对其中检出的Rh抗体孕妇,随访分娩,对孕妇及新生儿临床及实验室检查结果进行分析。结果 7年间,检出71例Rh同种抗体,阳性率0.40%,其中抗-D占26.76%(19/71),抗-E占46.48%(33/71),抗-Ec占9.86%(7/71),抗-C占7.04%(5/71),抗-Ce占5.63%(4/71),抗-c占2.82%(2/71),抗-e占1.41%(1/71)。71例孕妇中,分娩出新生儿溶血病者34例,总患病率为47.89%,其中抗-c组患儿患病率为100%,抗-D组患儿患病概率为78.94%,抗-E组分娩HDN患儿概率42.42%。重症换血患儿中71.43%(5/7)为抗-D,抗-E检出率最高,但患儿患病率低且多为轻症患者,在第1胎可发生,在胎龄、出生体重、黄疸出现时间方面与抗-D组并无统计学差别,但是抗-E组与抗-D组相比,总胆红素低、血红蛋白水平高(P均<0.05)。2例患儿死亡,其余患儿经光疗、白蛋白、丙球及输血换血等方式痊愈出院。结论 重视Rh抗体引起的新生儿溶血症的认识,尽早预防和治疗,提高患儿的治愈率。因此应加强Rh-HDN知识的宣传教育,针对高危人群,做到早发现、早干预以改善预后。Objective To retrospectively investigate the antibody distribution and pregnancy outcome of pregnant women with Rh alloantibody in Guangzhou, and summarize the prevalence, diagnosis and treatment experience of hemolytic disease of newborn(HDN) caused by Rh alloantibody, so as to provide data for the prevention, diagnosis and treatment of Rh-HDN.Methods A total of 17 345 pregnant women in Guangzhou from January 2014 to December 2020 were selected for irregular antibody screening test.Those with Rh antibody were followed up for delivery, and the clinical and laboratory examination results of pregnant women and newborns were analyzed.Results A total of 71 cases(0.41%,17/17 345) with Rh alloantibodies were detected.Among them, anti-D,anti-E,anti-Ec, anti-C,anti-Ce, anti-c, anti-e accounted for 26.76%(19/71),46.48%(33/71),9.86%(7/71),7.04%(5/71),5.63%(4/71),2.82%(2/71) and 1.41%(1/71),respectively.Among the 71 pregnant women, 34 gave birth to children with HDN,with the total prevalence rate of 47.89%,among whom 100%,78.94% and 42.42% were anti-c, anti-D and anti-E,respectively.And 71.43%(5/7) of the children who underwent transfusion were with anti-D.Although the yield rate of anti-E was the highest, it involved low morbidity and mild symptoms, which preferred to occur in the first fetus.No significant difference in gestational age, birth weight and the occurrence time of jaundice was notice between the anti-D group and anti-E group, but the total bilirubin of the anti-E group was lower while the Hb level were higher than those of the anti-D group(P<0.05).Two children died, and others were cured by phototherapy, albumin, IVIG and blood transfusion.Conclusion The publicity of Rh-HDN for early prevention and treatment should be strengthened to improve the cure rate and the prognosis.

关 键 词：孕妇 RH血型抗体 新生儿溶血病 

分 类 号：R457.11[医药卫生—治疗学] R714.15[医药卫生—临床医学]