中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2013年
3期
153-156
,共4页
陈诚%常青%王延洲%王琳%周乐
陳誠%常青%王延洲%王琳%週樂
진성%상청%왕연주%왕림%주악
ABO血型系统%血型不合%幼红细胞增多症,胎儿%孕妇%免疫球蛋白G%治疗结果
ABO血型繫統%血型不閤%幼紅細胞增多癥,胎兒%孕婦%免疫毬蛋白G%治療結果
ABO혈형계통%혈형불합%유홍세포증다증,태인%잉부%면역구단백G%치료결과
Maternal-fetal ABO blood incompatibility%Intrauterine fetus hemolysis%Neonatal hemolysis%Treatment outcomes
目的 探讨母胎ABO血型不合孕妇血型IgG抗体效价与围产儿溶血病的关系.方法 2009年1月31日至2010年1月31日,在第三军医大学西南医院妇产科进行产前检查的母胎ABO血型不合的单胎妊娠孕妇共1269例.于妊娠28～30周取血清检测孕妇血型IgG抗体效价,分娩时取新生儿脐血查新生儿血型,并进行新生儿溶血病(hemolytic disease of the newborn,HDN)的血清学试验.回顾分析孕妇血清ABO血型IgG抗体效价及围产儿溶血病的发生情况,采用Kendall等级相关分析法分析孕妇血型抗体效价与围产儿溶血病之间的相关性. 结果 妊娠28～30周,58.4％(741/1269)的孕妇血清中未检测出ABO血型IgG抗体.5.1％(65/1269)的孕妇抗体滴度≥1∶128,妊娠36周复查时,17例抗体效价倍增,但均未超过1∶ 512,所有胎儿未发现水肿或胸腹腔积液等宫内溶血征象.380例新生儿诊断为HDN,占29.9％(380/1269).其中12例新生儿出生24 h内出现轻度贫血貌和(或)黄疸症状,占HDN患儿总数的3.2％(12/380).随IgG抗体效价增加,HDN发生率增加,二者存在相关性(Tb=-0.293,P＜0.01).当IgG抗体效价＝1∶128时,HDN发生率为85.4％(35/41),当IgG抗体效价=1∶ 512时,HDN发生率为5/5,呈显著增加趋势(x2=108.906,P＜0.01).380例新生儿中,322例转入本院新生儿重症监护病房接受以蓝光治疗为基础的综合治疗,其中2例行换血治疗,均痊愈出院. 结论 母胎ABO血型不合胎儿溶血发生率极低,妊娠期无需特殊处理；妊娠期进行ABO抗体效价检测,有利于及时诊断HDN并及时处理.
目的 探討母胎ABO血型不閤孕婦血型IgG抗體效價與圍產兒溶血病的關繫.方法 2009年1月31日至2010年1月31日,在第三軍醫大學西南醫院婦產科進行產前檢查的母胎ABO血型不閤的單胎妊娠孕婦共1269例.于妊娠28～30週取血清檢測孕婦血型IgG抗體效價,分娩時取新生兒臍血查新生兒血型,併進行新生兒溶血病(hemolytic disease of the newborn,HDN)的血清學試驗.迴顧分析孕婦血清ABO血型IgG抗體效價及圍產兒溶血病的髮生情況,採用Kendall等級相關分析法分析孕婦血型抗體效價與圍產兒溶血病之間的相關性. 結果 妊娠28～30週,58.4％(741/1269)的孕婦血清中未檢測齣ABO血型IgG抗體.5.1％(65/1269)的孕婦抗體滴度≥1∶128,妊娠36週複查時,17例抗體效價倍增,但均未超過1∶ 512,所有胎兒未髮現水腫或胸腹腔積液等宮內溶血徵象.380例新生兒診斷為HDN,佔29.9％(380/1269).其中12例新生兒齣生24 h內齣現輕度貧血貌和(或)黃疸癥狀,佔HDN患兒總數的3.2％(12/380).隨IgG抗體效價增加,HDN髮生率增加,二者存在相關性(Tb=-0.293,P＜0.01).噹IgG抗體效價＝1∶128時,HDN髮生率為85.4％(35/41),噹IgG抗體效價=1∶ 512時,HDN髮生率為5/5,呈顯著增加趨勢(x2=108.906,P＜0.01).380例新生兒中,322例轉入本院新生兒重癥鑑護病房接受以藍光治療為基礎的綜閤治療,其中2例行換血治療,均痊愈齣院. 結論 母胎ABO血型不閤胎兒溶血髮生率極低,妊娠期無需特殊處理；妊娠期進行ABO抗體效價檢測,有利于及時診斷HDN併及時處理.
목적 탐토모태ABO혈형불합잉부혈형IgG항체효개여위산인용혈병적관계.방법 2009년1월31일지2010년1월31일,재제삼군의대학서남의원부산과진행산전검사적모태ABO혈형불합적단태임신잉부공1269례.우임신28～30주취혈청검측잉부혈형IgG항체효개,분면시취신생인제혈사신생인혈형,병진행신생인용혈병(hemolytic disease of the newborn,HDN)적혈청학시험.회고분석잉부혈청ABO혈형IgG항체효개급위산인용혈병적발생정황,채용Kendall등급상관분석법분석잉부혈형항체효개여위산인용혈병지간적상관성. 결과 임신28～30주,58.4％(741/1269)적잉부혈청중미검측출ABO혈형IgG항체.5.1％(65/1269)적잉부항체적도≥1∶128,임신36주복사시,17례항체효개배증,단균미초과1∶ 512,소유태인미발현수종혹흉복강적액등궁내용혈정상.380례신생인진단위HDN,점29.9％(380/1269).기중12례신생인출생24 h내출현경도빈혈모화(혹)황달증상,점HDN환인총수적3.2％(12/380).수IgG항체효개증가,HDN발생솔증가,이자존재상관성(Tb=-0.293,P＜0.01).당IgG항체효개＝1∶128시,HDN발생솔위85.4％(35/41),당IgG항체효개=1∶ 512시,HDN발생솔위5/5,정현저증가추세(x2=108.906,P＜0.01).380례신생인중,322례전입본원신생인중증감호병방접수이람광치료위기출적종합치료,기중2례행환혈치료,균전유출원. 결론 모태ABO혈형불합태인용혈발생솔겁저,임신기무수특수처리；임신기진행ABO항체효개검측,유리우급시진단HDN병급시처리.
Objective To investigate the relationship between IgG antibody titer in pregnant women with maternal-fetal ABO blood incompatibility and hemolytic disease of fetuses and newborns.Methods From January 31 2009 to January 31 2010,1269 singleton pregnant women who were suspected to have maternal fetal ABO blood incompatibility in Department of Obstetrics and Gynecology,Southwest Hospital,Third Military University were collected.Anti-A or anti-B IgG titers of them were detected at 28-30 gestational age,and umbilical cord blood were taken when delivery and hemolytic disease of the newborn serological test were done to diagnose hemolytic disease of the newborn (HDN).The relationship between the titers and incidence of fetal or neonatal hemolytic disease was retrospectively analyzed by Kendall tau rank correlation.Results No IgG of anti-A or anti-B in serum were found in 58.4％ (741/1269) pregnant women,while the antibody titer of 5.1％ (65/1269) pregnant women were more than or equal to 1 ∶ 128.When they were tested again at 36 gestational week,the titer of 17 cases increased twice but lower than 1 ∶ 512.No signs of intrauterine hemolysis,such as edema,ascites and pleural effusion,were found.Three hundred and eighty neonates (29.9％,380/1269) were diagnosed as HDN.Among which,12 cases (3.2％,12/380) showed mild anemia and (or) jaundice within 24 hours after delivery.There was positive correlation between incidence of neonatal hemolysis and antibody titer(Tb=-0.293,P＜0.01).The incidence of HDN increased from 85.4％ (35/41) in women with antibody titer of 1 ∶ 128 to 5/5 inwomen with antibody titer at 1 ∶ 512 (x2=108.906,P＜0.01).Among 380 HDN neonates,322 cases were transferred to neonatal intensive care unit for phototherapy based comprehensive therapy,and two underwent exchange transfusion.All patients were cured.Conclusions The intrauterine hemolysis incidence of patients with suspected maternal-fetal ABO blood incompatibility is very low,and no special care is required during pregnancy.Anti-A or anti-B tests during pregnancy is helpful in early diagnosis and management of HDN.
