不规则抗体筛查及效价对新生儿溶血病的影响

Effects of irregular antibodies detection and antibody titers on neonatal hemolytic disease

目的:检测孕妇产前IgG抗A(B)及Rh血型抗体效价,探讨围产期孕妇在产前做不规则抗体筛查及抗体效价的临床意义。方法:①实验组:对475例夫妻血型不合的孕妇进行产前IgG抗A/B效价测定;Rh血型抗体筛选,并对效价≥64的孕妇给予临床干预,观察产后婴儿是否发生溶血及溶血出现的时间和程度等。②对照组:随机选择529例夫妻血型不合、产前未做不规则抗体筛查的产妇,观察其婴儿是否发生溶血及溶血出现的时间、程度等。结果:①实验组发生新生儿溶血6例(1.26%),其中24 h内发生1例,48 h发生1例,72 h发生3例,>72 h发生1例;对照组发生新生儿溶血41例(7.75%),其中24 h内发生5例,48 h发生21例,72 h发生12例,>72 h发生3例。两组比较差异有统计学意义(P<0.05);②实验组新生儿黄疸平均出现时间(63.56±17.67)h;对照组(44.39±26.95)h。实验组新生儿黄疸出现时间较对照组晚(P<0.05)。③实验组新生儿血清中总胆红素浓度(165.30±20.10)μmol/L;对照组(243.10±18.70)μmol/L。对照组黄疸程度较实验组严重(P<0.05)。结论:孕妇产前抗体效价测定可作为判断胎儿出生后是否发生新生儿溶血病的筛查指标,具有十分重要的临床意义。

Objective：To detect the antibody titers of anti-A（B） and Rh blood types of pregnant women before delivery,explore the clinical significances of irregular antibodies detection and antibody titers of perinatal women before delivery.Methods：①In experimental group,475 pregnant women with incompatible blood type received IgG anti-A（B） antibody titer detection and Rh blood type antibody screening,the pregnant women with antibody titer≥64 received clinical intervention,the incidence,appearance time and degree of hemolysis among the infants were observed.②In control group,529 pregnant women with incompatible blood type who didn＇t receive irregular antibodies detection before delivery were selected randomly,the incidence,appearance time and degree of hemolysis among the infants were observed.Results：①In experimental group,6 cases were found with neonatal hemolysis,accounting for 1.26%,one case occurred within 24 hours,one case occurred within 48 hours,3 cases occurred within 72 hours and one case occurred after 72 hours;in control group;41 cases were found with neonatal hemolysis,accounting for 7.75%,5 cases occurred within 24 hours,21 cases occurred within 48 hours,12 cases occurred within 72 hours and 3 cases occurred after 72 hours,there was significant difference between the two groups（P0.05）.②The average appearance times of neonatal jaundice in experimental group and control group were（63.56±17.67） hours and（44.39±26.95） hours,respectively.The average appearance time of neonatal jaundice in experimental group was latter than that in control group（P0.05）.③The total bilirubin concentrations in serum of experimental group and control group were（165.30±20.10） μmol/L and（243.10±18.70） μmol/L,respectively.The degree of jaundice in control group was severer than that in experimental group（P0.05）.Conclusion：Antibody titer detection among pregnant women before delivery can used as a screening index to predict the occurrence of neonatal hemolysis or not after birth,which has very important clinical significance.