脐血溶血试验及胆红素监测对新生儿ABO溶血病的预测价值  

Values of umbilical cord blood hemolysis test and bilirubin monitoring in the prediction of ABO hemolytic disease of the newborn

作　　者：卢建双 陆宁洁[1] 王楸[1] LU Jianshuang;LU Ningjie;WANG Qiu(Department of Neonatology,The First Affiliated Hospital of Wenzhou Medical University,Zhejiang Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院新生儿科,浙江温州325000

出　　处：《中国妇幼健康研究》2023年第10期20-26,共7页Chinese Journal of Woman and Child Health Research

基　　金：温州市基础性科研项目(Y2020459)。

摘　　要：目的探讨新生儿溶血试验及胆红素监测对ABO溶血病患儿的预测价值。方法选取2017年6月至2020年6月在温州医科大学附属第一医院出生的足月ABO溶血病患儿共596例,其中出生后出现需治疗的病理性黄疸有250例,纳入治疗组;出现病理性黄疸但无需治疗有346例,纳入观察组。将溶血试验结果分为A(放散试验阳性)、B(放散试验和游离抗体试验阳性)、C(放散试验和直接抗体试验阳性)、D(放散试验、游离抗体试验和直接抗体试验均阳性),分析不同溶血试验结果及胆红素监测与需要治疗的黄疸之间的关系。结果①治疗组与观察组的胎龄(Z=4.00)、出生体重(Z=2.21)、血型分布(χ^(2)=8.88)、直接抗体阳性率(χ^(2)=16.98)、游离抗体阳性率(χ^(2)=26.77)差异均有统计学意义(P<0.05)。②溶血试验结果A的患儿出现需治疗的病理性黄疸的比例明显低于结果B、D者(χ^(2)值分别为17.24、29.45,P<0.05)。③治疗组中,溶血试验结果A的患儿黄疸发生时间晚于结果B、D者(H值分别为37.65、50.85,P<0.05),结果A的患儿光疗时间较结果B、D者短(H值分别为-29.36、-56.77,P<0.05)。治疗组中A血型和B血型患儿的各溶血试验结果占比差异无统计学意义(P>0.05)。④治疗组出现黄疸的日龄与光疗时间呈负相关(r=-0.313,P<0.05)。结论ABO溶血病患儿放散试验阳性合并游离抗体试验阳性和/或直接抗体试验阳性时,需治疗的黄疸发生率及黄疸严重程度均较仅有放散试验阳性患儿高。A型血患儿发生需治疗的黄疸几率大,但B型血患儿溶血的严重程度较A型血患儿重。早期对母子ABO血型不合的新生儿进行溶血试验检测,联合每日监测黄疸,是早期预测ABO溶血患儿是否发生严重高胆红素血症的有效方法,以做早期预防。Objective To investigate the values of umbilical cord blood hemolysis test and bilirubin monitoring in the early prediction of ABO hemolytic disease of the newborn.Methods A total of 596 neonates with ABO hemolytic disease who were born in the First Affiliated Hospital of Wenzhou Medical University from June 2017 to June 2020 were selected,among which 250 cases with pathological jaundice requiring treatment after birth were included in the treatment group,and 346 patients with pathological jaundice without treatment were included in the observation group.Hemolysis test results were divided into A(positive release test),B(positive release test and free antibody test),C(positive release test and direct antibody test)and D(positive release test,free antibody test and direct antibody test).The associations between different hemolysis test results,bilirubin monitoring and jaundice requiring treatment were analyzed.Results①There were statistically significant difference of the gestational age(Z=4.00),birth weight(Z=2.21),typing of blood(χ^(2)=8.88),the positive rate of direct antibody(χ^(2)=16.98)and the positive rate of free antibody(χ^(2)=26.77)between the treatment group and the observation group(P<0.05).②The incidence of pathological jaundice requiring treatment in those with Hemolysis test result A was significantly lower than those with Hemolysis test result B and D(χ^(2)=17.24 and 29.45,respectively,P<0.05).③The onset time of jaundice in those with Hemolysis test result A was later than that in those with Hemolysis test result B and D(H=37.65 and 50.85,respectively,P<0.05),and the phototherapy duration in those with Hemolysis test result A was shorter than that in those with Hemolysis test result B and D(H=-29.36 and-56.77,respectively,P<0.05).In the treatment group,there was no difference of each hemolysis tests between the children with type A and type B blood(P>0.05).④The age at the time of jaundice onset was negatively correlated with the phototherapy duration(r=-0.313,P<0.05).Conclusion The inci

关 键 词：新生儿ABO溶血病 溶血试验 黄疸监测 血型不合 

分 类 号：R174[医药卫生—妇幼卫生保健]