母儿ABO血型不合溶血病防治的临床观察

Clinical evaluation of the prevention and treatment in ABO hemolytic disease of the newborn

目的:探讨防治母儿ABO血型不合溶血病(ABO-HDN)的有效方法及临床价值。方法:56例母儿ABO血型不合病例分为1组(未加用中药组)和2组(加用中药组),测定孕妇血清抗体效价以及新生儿脐血胆红素和血红蛋白值,比较两组孕妇血清抗体效价下降情况、新生儿ABO-HDN阳性率和脐血胆红素、血红蛋白值,并分析分娩当天孕妇血清抗体效价与脐血胆红素、血红蛋白的相关性。结果:两组相比抗体效价下降效果(χ2=14.25,P<0.01)和ABO-HDN阳性率(χ2=4.28,P<0.05)差异有显著性,但脐血胆红素、血红蛋白差异无显著性;分娩当天孕妇血清抗体效价与脐血总胆红素(r=0.12,P=0.39)、间接胆红素(r=0.09,P=0.52)、血红蛋白(r=0.15,P=0.28)无显著相关性。结论:对有母儿血型不合危险倾向的孕妇采用中药治疗降低抗体效价的同时,尽早确诊ABO-HDN阳性患儿并给予预防性退黄治疗可避免严重溶血病的发生。

Objective To study the effective method and evaluate the clinical significance in prevention and treatment of ABO hemolytic disease of the newborn（ABO-HDN） . Methods Fifty-six cases of maternal-fetal ABO blood group incompatibility were divided into two groups： 1 group （western medicine group） and 2 group （Chinese traditional and western medicine group） . The changes of maternal serum antibody titer and the HDN positive rates were statistically analyzed; the umbilical serum bilirubin and hemoglobin were determined, then we analyzed the correlation between the maternal serum antibody titer and the umbilical serum bilirubin and hemoglobin. Results Significant difference of maternal serum antibody titer changes were found in the two groups（χ^2= 14. 25, P 〈0.01 ）; the positive rate of ABO-HDN in 2 group was significantly lower than in 1 group（χ^2=4. 28, P〈0. 05） while the umbilical serum bilirubin and hemoglobin hadn＇t significant difference; The hemolytic degree of the newborns hadn＇t significant correlation with maternal serum antibody titer （Total bilirubin： r=0. 12, P=0. 39; Indirect bilirubin： r=0. 09, P=0. 52; Hemoglobin： r =0. 15, P=0. 28）. Conclusions For the pregnant women at the risk of ABO blood group incompatibility, we can apply Chinese traditional medicine to decrease the level of maternal serum antibody. Moreover, the ABO-HDN newborns should be diagnosed and treated as early as possible in order to prevent the severe jaundice and anaemia.