中等剂量静脉用丙种球蛋白治疗新生儿ABO溶血性黄疸

Effects of medium doses of IVIG on 77 newborn infants with ABO hemolytic disease

目的比较静脉注射用丙种球蛋白(简称:静丙,IVIG)中等剂量(2.5g,1次)与大剂量(1g/kg,1次)治疗新生儿重症ABO溶血病的疗效。方法足月新生儿(体重≥3kg)重症ABO溶血病在常规光疗基础上加用静丙:A组45例,用中等剂量(不依据体重,用1次静丙2.5g);B组32例,用大剂量(按照体重用1次静丙1g/kg);C组20例(对照组),未用静丙。3组的入院日龄、胎龄、黄疸出现时间、血清总胆红素(简称总胆)浓度均相匹配。比较3组总胆红素(TSB)下降的疗效。结果入院时A、B、C组TSB峰值的均值范围相同(270μmo/L),治疗后,3组TSB均持续下降,入院24h差异不大(P>0.05),以后48h均下降。A、B组TSB持续下降明显,分别下降147、159μmol/L(两组比较,P>0.05)。C组下降较慢,48h仅下降109μmol/L,且费时更长,平均约84.5h胆红素下降到生理水平,与A、B组比较差异有统计学意义。结论ABO溶血病应及早用IVIG,但两种剂量疗效差异不大,推荐使用中等剂量,避免医疗资源浪费。

Objective To observe the therapeutic effects of intravenous immunoglobulin（ IVIG） between high dose（ 1 g/kg） and medium dose（ 2. 5 g） on severe ABO hemolytic disease of newborn. Methods 77 term infants with severe hyperbilirubinemia receiving IVIG were divided into 2 groups. 45 cases in group A with medium dose,while 32 cases in group B with high dose,another 20 cases without IVIG in group C. Phototherapy were used concomitantly for all infants in 3 groups. The days of life on admission,time of jaundice,and peak of serum bilirubin concentration（ TB） in each group were matched. The decrease of TB between each group were compared. Results The range of TB（ MTB） in 3 groups was 270 μmo/L. After treatment,the MTB declined without obvious significance in 24 h among 3 groups（ P 0. 05） . The MTB in group A and group B declined consistently to 147μmol/L,159μmol/L within 24 ～ 48 h（ P 0. 05） . While MTB of group C declined to 109 μmol/L within 48 h,and it declined to physiological levels of bilirubin in an average of about 84. 5 h（ compared with group A and group B,P 0. 05） . Conclusion IVIG should be used as early as possible on severe ABO hemolytic disease. The effect of high dose and medium dose has little difference. The medium dose is recommended to avoid the waste of medical resources.