孕妇血清高效价IgG血型抗体亚型分析与胎儿新生儿溶血病及高胆红素血症发生率的相关性研究  

Analysis of High Titer IgG Blood Group Antibody Subtype in Pregnant Women’s Serum and Its Correlation with the Incidence of Hemolytic Disease and Hyperbilirubinemia of the Fetus and Newborn

作　　者：夏爱军 樊文昕 黄珊珊 郝茜 赵雅琦 XIA Ai-jun;FAN Wen-xin;HUANG Shan-shan;HAO Xi;ZHAO Ya-qi(Department of Blood Transfusion,Xi’an Daxing Hospital,Xi’an 710016,China;Department of Dermatology,Xi’an People’s Hospital/the Fourth Hospital of Xi’an,Xi’an 710005,China)

机构地区：[1]西安大兴医院输血科,西安710016 [2]西安市人民医院/西安市第四医院皮肤激光治疗中心,西安710005

出　　处：《现代检验医学杂志》2023年第2期181-185,共5页Journal of Modern Laboratory Medicine

基　　金：2020年西安市卫生健康委员会科研项目(NO2020yb74)。

摘　　要：目的研究高效价IgG血型抗体孕妇血清中IgG亚型与胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)及高胆红素血症发生率的相关性,评价IgG亚型检测的临床价值。方法对2020年1月~2021年10月在西安大兴医院进行产前免疫血清学检测的225例高效价IgG抗体孕妇(其中ABO血型系统217例,Rh血型系统8例),采用微柱凝胶技术检测其IgG亚型,对新生儿脐血进行新生儿溶血系列检测,生化分析仪检测新生儿血清胆红素水平,分析孕妇血清IgG亚型与HDFN及高胆红素血症发生率的相关性。结果217例高效价IgG抗-A(B)孕妇血清中IgG1/IgG3亚型134例(占比61.75%),IgG1/IgG3混合型18例(占比8.29%),IgG2/IgG4亚型检出65例(占比29.95%);8例高效价Rh系统IgG抗体均为IgG1和/或IgG3亚型,未检出IgG2或IgG4亚型。IgG1/IgG3亚型组中HDFN发生率为79.29%(111/140),高胆红素血症发生率为55.71%(78/140);IgG1/IgG3混合型组中HDFN发生率为90.00%(18/20),高胆红素血症发生率为70.00%(14/20);IgG2/IgG4亚型组中HDFN发生率为15.38%(10/65),未发生高胆红素血症。IgG1/IgG3亚型组与IgG1/IgG3混合型组HDFN及高胆红素血症发生率比较差异无统计学意义(χ^(2)=0.692,1.461,均P>0.05);IgG抗体效价1∶256及效价1∶512,HDFN发生率分别为64.28%,56.94%,IgG1/IgG3单独存在组、混合型组和IgG2/IgG4组随抗体效价增高HDFN发生率未增加,差异均无统计学意义(χ^(2)=0.231,2.813,均P>0.05)。结论血型抗体高效价孕妇血清中IgG亚型类别与HDFN及高胆红素血症发生率具有相关性,产前检测血型抗体IgG亚型,对HDFN及高胆红素血症的精准预防和治疗具有指导意义。Objective To study the correlation between high titer IgG blood group antibody subtypes in pregnant women and postpartum hemolytic disease and hyperbilirubinemia of the newborn(HDFN),in order to evaluate the clinical value of IgG subtype detection.Methods Serum IgG subtypes were detected by microcolum gel technology assay in 225 pregnant women with high titer antibody[217 of ABO blood group system and 8 of Rh system]before delivery from January 2020 to October 2021 in Xi’an Daxing Hospital.Neonatal hemolysis tests and serum bilirubin levels in the umbilical cord blood of the new born were detected.The relationship between serum IgG subtype of pregnant women and HDFN and the incidence of hyperbilirubinemia were analyzed.Results There were 134 cases of IgG1/IgG3 subtype(61.75%),18 cases of IgG1/IgG3 mixed subtype(8.29%)and 65 cases of IgG2/IgG4 subtype(29.95%)in the serum of 217 pregnant women with high titer ABO system IgG anti-A(B).The 8 cases of high titer Rh system IgG antibodies were all of IgG1 and/or IgG3 subtype,no IgG2 or IgG4 subtype was detected.In the IgG1/IgG3 subtype group,the incidence of HDFN was 79.29%(111/140),and the incidence of hyperbilirubinemia was 55.71%(78/140).In the mixed IgG1/IgG3 group,the incidence of HDFN was 90%(18/20),and the incidence of hyperbilirubinemia was 70%(14/20).In the IgG2/IgG4 subtype group,the incidence of HDFN was 15.38%(10/65),and no hyperbilirubinemia occurred.There were no significant differences in the incidence of HDFN and hyperbilirubinemia between IgG1/IgG3 subtype group and IgG1/IgG3 mixed type group(χ^(2)=0.692,1.461,all P>0.05).The incidence of HDFN for IgG anti-A(B)titer 1∶256 and 1∶512 groups were 64.28%and 56.94%,respectively.The incidence of HDFN did not increase with higher antibody titer in the IgG1/IgG3,IgG1/IgG3 mixed and IgG2/IgG4 subtype groups(χ^(2)=0.231,2.813,all P>0.05).Conclusion The serum IgG subtype of pregnant women was closely related to the incidence of HDFN and hyperbilirubinemia.It is necessary to carry out prenatal detection of

关 键 词：孕妇 血型抗体 IGG亚型 胎儿新生儿溶血病 高胆红素血症 

分 类 号：R722.18[医药卫生—儿科] R457.11[医药卫生—临床医学]