RhD阴性孕产妇与HDFN发生的相关性及影响因素分析  

Analysis of Correlation and Influencing Factors between RhD Negative Pregnant Women and the Occurrence of HDFN

作　　者：陈婷婷[1] 黄蓉[1] 凌玉 胡文静 CHEN Tingting;HUANG Rong;LING Yu;HU Wenjing(Department of Medical Laboratory,Women's Hospital of Nanjing Medical University,Nanjing Women and Children's Healthcare Hospital,Nanjing 210001)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)检验科,江苏南京210001

出　　处：《临床输血与检验》2024年第3期338-345,共8页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：江苏省输血协会英科新创科研基金项目(No.JSYK2023002)资助。

摘　　要：目的 通过对RhD阴性孕产妇腹中胎儿和分娩的新生儿发生胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)的相关指标对比分析,为预防和治疗HDFN提供参考和指导。方法 收集我院2018年1月—2022年12月分娩的RhD阴性孕产妇737名,比较新生儿是否发生RhD血型不合、ABO血型不合导致的HDFN及其影响因素,发生RhD-HDFN和发生ABO-HDFN的相关影响因素。分析发生RhD-HDFN和发生ABO-HDFN患儿的实验室指标差异;分析IgG抗-D效价≤16和≥32的孕产妇分娩的新生儿发生RhD-HDFN的实验室指标差异。结果 737名RhD阴性孕产妇中,发生RhD-HDFN的母婴ABO血型相同或相容者比率88.89%(40/45)显著高于母婴ABO血型不相容者11.11%(5/45)。母体二次妊娠及以上发生RhD-HDFN比率93.33%(42/45)显著高于ABO-HDFN 60.66%(37/61)者。母体IgG抗-D效价≥32者分娩的新生儿血红蛋白(hemoglobin,Hb)最低值低于母体IgG抗-D效价≤16者(χ^(2)=5.61,P<0.05),母体IgG抗-D效价≥32者分娩的新生儿血清总胆红素(total bilirubin,TBil)峰值高于IgG抗-D效价≤16者(χ^(2)=4.471,P<0.05)。结论 RhD阴性孕产妇中,母婴ABO血型相同或相容及孕产次≥2者,相应新生儿更易发生RhD-HDFN,母体IgG抗-D效价≥32者发生新生儿溶血的严重程度显著高于抗-D效价≤16者。Objective By comparing and analyzing the related indexes of hemolytic disease of the fetuses and newborn(HDFN)in fetuses and newborns delivered by RhD-negative pregnant women,we can provide reference and guidance for the prevention and treatment of HDFN.Method A total of 737 RhD-negative pregnant women who gave birth in our hospital from January 2018 to December 2022 were collected.The relative factors of HDFN caused by RhD blood group incompatibility and ABO blood group incompatibility,RhD-HDFN and ABO-HDFN were compared.Moreover,the differences of laboratory indexes between RhD-HDFN and ABO-HDFN and RhD-HDFN in newborns with IgG anti-D titer≤16 and≥32 were analyzed.Results Among 737 RhD-negative pregnant women,88.89%(40/45)had the same or compatible ABO blood type between mother and infant,which was significantly higher than 11.11%(5/45)in mother-infant ABO blood type incompatibility.Maternal second pregnancy and above births had a 93.33%(42/45)RhD-HDFN rate which was significantly higher than the 60.66%(37/61)ABO-HDFN rate.In addition,the lowest hemoglobin value in newborns born to mothers with IgG anti-D titers≥32 was significantly lower than that of mothers with IgG anti-D titers≤16(χ^(2)=5.61,P<0.05).As expected,the peak value of serum total bilirubin in newborns born to mothers with IgG anti-D titers≥32 was higher than those with IgG anti-D titers≤16(χ^(2)=4.471,P<0.05).Conclusion Among RhD-negative pregnant women,those with the same or compatible ABO blood type and gravidity and parity history≥2 are more likely to develop RhD-HDFN in their corresponding newborns and the severity of neonatal hemolysis is significantly higher in those with maternal IgG anti-D titer≥32 than in those with anti-D titer≤16.

关 键 词：RhD阴性孕产妇 胎儿和新生儿溶血病 换血疗法 抗-D免疫球蛋白 

分 类 号：R457[医药卫生—治疗学]