网织红细胞比率、γ-谷氨酰转移酶、乳酸脱氢酶联合检测对ABO新生儿溶血病的评估价值  

Evaluation value of reticulocyte ratio,γ-glutamyltransferase and lactate dehydrogenase combined test in hemolytic disease of ABO neonates

作　　者：张倩 李秋琼 陈阿阮 杨辉 ZHANG Qian;LI Qiuqiong;CHEN A’ruan;YANG Hui(Blood Transfusion Department,Hainan Women and Children’s Medical Center,Haikou,Hainan 570216,China;Neonatology Department,Hainan Women and Children’s Medical Center,Haikou,Hainan 570216,China)

机构地区：[1]海南省妇女儿童医学中心输血科,海南海口570216 [2]海南省妇女儿童医学中心新生儿科,海南海口570216

出　　处：《中国优生与遗传杂志》2024年第12期2649-2653,共5页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨网织红细胞比率(RET%)、γ-谷氨酰转移酶(γ-GT)、乳酸脱氢酶(LDH)联合检测对ABO新生儿溶血病(HDN)的评估价值。方法选取O型Rh(D)阳性,且与丈夫血型不同的产妇180例,均检测静脉血RET%、γ-GT、LDH水平。根据ABO-HDN发生情况分ABO-HDN组、非ABO-HDN组。受试者操作特征(ROC)曲线、决策曲线及临床影响曲线分析RET%、γ-GT、LDH评估ABO-HDN的效能。结果ABO-HDN组RET%、γ-GT、LDH高于非ABO-HDN组(P<0.05)。在模型1中无调整因素条件下,RET%、γ-GT、LDH每增加1%,ABO-HDN发生风险分别增加3.053倍、3.210倍、2.971倍(P<0.05);在模型2中调整产妇年龄、孕次、产妇血型后,RET%、γ-GT、LDH每增加1%,ABO-HDN发生风险分别增加2.952倍、2.798倍、2.503倍(P<0.05);模型3中调整产妇年龄、孕次、产妇血型、白细胞计数、中性粒细胞、血红蛋白后,RET%、γ-GT、LDH每增加1%,ABO-HDN发生风险分别增加2.504倍、2.546倍、2.091倍(P<0.05)。RET%、γ-GT、LDH联合检测评估ABO-HDN的AUC值为0.861。绘制决策曲线,在阈值0.1~1.0内,RET%、γ-GT、LDH联合评估ABO-HDN的净受益率优于单独检测,在阈值概率为0.23时被联合检测方案划分入高风险的人数与真阳性人数基本达成一致。结论RET%、γ-GT、LDH均是ABO-HDN发生的重要影响因素,检测静脉血RET%、γ-GT、LDH水平可为临床评估ABO-HDN发生风险提供参考。Objective To investigate the value of reticulocyte ratio(RET%),γ-glutamyltransferase(γ-GT)and lactate dehydrogenase(LDH)combined detection in the evaluation of ABO neonatal hemolytic disease(HDN).Methods A total of 180 women with O-type Rh(D)positive and different blood type from their husbands were selected.RET%,γ-GT and LDH levels of venous blood were detected.According to the occurrence of ABO-HDN,they were divided into ABO-HDN group and non-ABO-HDN group.Receiver operating characteristic(ROC)curve,decision curve,and clinical impact curve analysis of RET%,γ-GT,LDH were used to evaluate the efficacy of ABO-HDN alone.Results RET%,γ-GT and LDH in ABO-HDN group were higher than those in non-ABO-HDN group(P<0.05).Under the condition of no adjustment factors in model 1,the occurrence risk of ABO-HDN increased 3.053 times,3.210 times and 2.971 times for every 1%increase in RET%,γ-GT and LDH,respectively(P<0.05).In Model 2,the risk of ABO-HDN increased by 2.952 times,2.798 times and 2.503 times for every 1%increase in RET%,γ-GT and LDH after adjusting maternal age,gestational number and maternal blood type,respectively(P<0.05).In Model 3,after adjusting maternal age,pregnancy number,maternal blood type,white blood cell count,neutrophil and hemoglobin,the risk of ABO-HDN increased 2.504 times,2.546 times and 2.091 times for every 1%increase in RET%,γ-GT and LDH,respectively(P<0.05).The AUC values of ABO-HDN evaluated by the combined detection of the three were 0.861.The decision curve showed that the net benefit rate of the combined assessment of ABO-HDN by RET%,γ-GT and LDH was better than that of the single detection within the threshold range of 0.1–1.0.When the threshold probability was 0.23,the number of people classified as high risk by the combined detection scheme was basically consistent with the number of true positive people.Conclusion RET%,γ-GT,LDH are all important factors affecting the occurrence of ABO-HDN.Detection of RET%,γ-GT,LDH levels in venous blood can provide a reference for clinical

关 键 词：网织红细胞比率 Γ-谷氨酰转移酶 乳酸脱氢酶 ABO新生儿溶血病 

分 类 号：R72[医药卫生—儿科]