Rh阴性孕妇血型D抗原同种免疫反应研究

D antigen alloimmunity in Rh-negative pregnant women

目的研究Rh阴性孕妇血型D抗原同种免疫反应,为建立有区别的D亚型的输血规则提供参考。方法对RhD阴性孕妇进行基因分型,并检测是否有抗-D;总结分析孕妇妊娠次数以及胎儿红细胞的检出与产生抗-D之间的相关性。结果在122名RhD表型阴性的孕妇中,检出d/d基因型97例,Del型20例,弱D15型1例,RHD-CE(2—9)-D/d融合基因型3例,DⅥⅢ型1例。在97名RhD阴性(d/d)孕妇中,有38例产生抗-D;20名Del血型孕妇均未检出抗-D;3名RhD-CE(2—9)-D/d中有2例产生抗-D;1名弱D15型的孕妇未检出抗-D;1名DⅥⅢ型孕妇抗-D检出阳性。统计分析表明孕妇的妊娠次数以及外周血中检出胎儿红细胞的检出与抗-D的产生有相关性,这可以成为Rh阴性孕妇被D抗原免疫的证据。结论不同D亚型的个体可能会对D抗原有不同的免疫反应,我们认为在中国Del血型的受者可以接收D阳性血液。建立有区别的输血规则可以节约有限的Rh阴性血资源和提高输血安全。

Objective To study the D antigen alloimmunity in Rh-negative pregnant women to achieve the goal as finally establish a distinctive rule of transfusion for D-variant individuals. Methods RHD gene typing was performed on all RhD-pregnant women, and allo-anti-D was also detected. The relationship between the occurrence of anti-D and the number of pregnancies and the detection of fetal erythrocytes in maternal peripheral blood was analyzed. Results A total of 97 cases of real Rh-negative, 20 cases of Del, one case of week D 15, 3 cases of RHD-CE（2-9）-D/d and one case of DⅥ Ⅲ were detected in 122 cases of Rh-negative pregnant women.Totally 38 cases of allo-anti-D positive records were collected in 97 real Rh-negative pregnant women as 2 cases of allo-anti-D positive records in 3 cases of RHD-CE（2-9）-D/d and one case in DⅥ Ⅲ.But no anti-D was detected in Del and week D 15. Statistical analysis showed that the occurrence of allo-anti-D in Rh-negative pregnant women was conspicuously related to the number of pregnancies and the detection of fetal erythrocytes in the mother. Conclusion Different D-variant individuals have different alloimmunity against D antigen, we suggest that a Del recipient in China can be transfused with Rh-positive blood. Establishing a distinctive transfusion rule for D-variant individuals can save the rare Rh-negative blood and enhance the safety of transfusion.