母亲免疫球蛋白G不规则抗体效价及其效价积分对母婴Rh血型不合新生儿溶血病患儿换血治疗的预测分析  

Predictive analysis of maternal immunoglobulin G irregular antibody titer and titer score on blood exchange transfusion in rhesus maternal-fetal blood group incompatibility hemolytic disease of newborn

作　　者：郝萧 刘兴莉 夏小叶 刁雪芹 姚美雪 Xiao Hao;Xingli Liu;Xiaoye Xia;Xueqin Diao;Meixue Yao(Jinan Blood Supply and Insurance Center,Jinan 250001,Shandong Province,China;Department of Blood Transfusion,Shandong University Qilu Children′s Hospital,Jinan 250001,Shandong Province,China;Department of Epidemiology,School of Public Health,Xuzhou Medical University,Xuzhou 221004,Jiangsu Province,China)

机构地区：[1]济南市血液供保中心,济南250001 [2]山东大学齐鲁儿童医院输血科,济南250001 [3]徐州医科大学公共卫生学院流行病学教研室,徐州221004

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第6期677-684,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金青年科学基金项目(81703272);徐州医科大学优秀人才科研启动基金项目(D2017013)。

摘　　要：目的探讨母亲免疫球蛋白(Ig)G不规则抗体效价及其效价积分对母婴Rh血型不合新生儿溶血病(Rh-HDN)患儿换血治疗的预测效果。方法选择2019—2021年,于济南市血液供保中心血型室确诊为Rh-HDN的52例患儿为研究对象。根据其是否接受换血治疗,将其分别纳入换血组(n=28)与未换血组(n=24)。检测2组患儿红细胞计数(RBC)、血红蛋白(Hb)含量、血细胞比容(HCT)、血清总胆红素(TBIL)浓度、ABO血型与其母亲IgG不规则抗体效价及其效价积分,并采用成组t检验或χ2检验进行统计学比较。绘制2组患儿母亲IgG不规则抗体效价及其效价积分预测Rh-HDN患儿换血治疗的受试者工作特征(ROC)曲线,并计算其曲线下面积(AUC)。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。2组患儿性别构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。结果①换血组患儿RBC、Hb含量、HCT均显著低于未换血组患儿,而血清TBIL则显著高于未换血组患儿,并且差异均有统计学意义(t=-7.94、-7.96、-8.80、14.24,P<0.001)。②换血组患儿母亲IgG不规则抗体效价及其效价积分,均显著高于未换血组,并且差异均有统计学意义(Z=-4.91、t=8.72,P<0.001)。③对患儿母亲IgG不规则抗体效价及其效价积分,对2组Rh-HDN患儿换血治疗预测结果进行配对χ2检验比较显示,差异统计学意义(P=0.031)。患儿母亲IgG不规则抗体效价及其效价积分,对预测Rh-HDN患儿换血治疗的AUC分别0.921(95%CI:0.853~0.990,P<0.001)与0.958(95%CI:0.910~1.000,P<0.001),并且差异有统计学意义(Z=2.09,P=0.036)。根据约登指数最大原则,患儿母亲IgG不规则抗体效价及其效价积分,对预测患儿换血治疗的最佳临界值分别为1∶80、57.5分,并且预测2组患儿换血治疗的敏感度分别为71.4%与92.9%,特异度均为87.5%,阳性预测值分别为87.0%与89.7%,阴性预测值分别为72.4%与91.3%。结论Rh-HDNObjective To investigate the predictive effect of maternal immunoglobulin(Ig)G irregular antibody titer and titer score on blood exchange transfusion in rhesus maternal-fetal blood group incompatibility hemolytic disease of newborn(Rh-HDN).Methods From 2019 to 2021,52 newborns who were diagnosed as Rh-HDN in the Blood Group Room of Jinan Blood Supply and Insurance Center were selected as research subjects.According to whether Rh-HDN newborns received blood exchange transfusion or not,they were divided into exchange transfusion group(n=28)and non-exchange transfusion group(n=24).Their red blood cell count(RBC),level of hemoglobin(Hb),hematocrit(HCT),serum total bilirubin(TBIL)concentration,ABO blood group and maternal IgG irregular antibody titer and titer score were detected,and were statistically compared by independent-samples t test or chi-square test.Receiver operating characteristic(ROC)curve of maternal IgG irregular antibody titer and titer score for predicting blood exchange transfusion of Rh-HDN newborns were drawn,and the area under the curve(AUC)was also calculated.The procedures followed in this study were in line with the requirements of Helsinki Declaration of the World Medical Association revised in 2013.There was no significant difference between two groups in terms of general clinical data,such as gender composition ratio(P>0.05).Results①RBC,level of Hb,HCT in exchange transfusion group were significantly lower than those in non-exchange transfusion group,while serum TBIL concentration was significantly higher than that in non-exchange transfusion group,and all the differences were statistically significant(t=-7.94,-7.96,-8.80,14.24;P<0.001).②The maternal IgG irregular antibody titer and titer score in exchange transfusion group were significantly higher than those in non-exchange transfusion group,and the differences were statistically significant(Z=-4.91,t=8.72;P<0.001).③There was statistically significant difference between maternal antibody titer and titer score for predicting blood exc

关 键 词：RH-HR血型系统 血型不合 新生儿溶血病 抗体效价 效价积分 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]