红细胞血型抗体亚类与新生儿溶血病关系的研究

Study on the relationship between blood subtype and hemolytic disease of newborn

目的:研究新生儿红细胞血型抗体亚类IgG1、IgG2、IgG3、IgG4及孕妇血清IgG抗A(B)对引起新生儿溶血病(HDN)的影响。方法:运用微柱凝胶免疫技术(MGIA)对652例夫妇血型不合的孕妇血清IgG抗A(B)进行抗体效价检测,效价≥64为阳性;运用透射免疫比浊法(ITA)对25例HDN患儿红细胞放散液血型抗体亚类IgG1、IgG2、IgG3和IgG4进行检测,有相应抗体为阳性。结果:652例夫妇血型不合的孕妇中IgG抗A(B)阳性218例(33.4%),4例Rh血型不合的抗体均为阴性。218例阳性抗体中继承父亲的抗体201例,与父亲无关的抗体17例,发生HDN者25例(11.5%);患儿红细胞血型抗体亚类中引起HDN的抗体比例为IgG1(100%)>IgG3(80.0%)>IgG2(44.0%)>IgG4(4.0%)。其中IgG1、IgG3联合引起HDN者80%。结论:在夫妇血型不合的孕妇中,血型抗体效价与HDN发病率成正相关,引起HDN的主要血型抗体亚类是IgG1和IgG3,IgG1的作用机制更强,多数情况2者联合引起HDN。

Objective:To study the influence of the valence of IgG1, IgG2,IgG3 or IgG4 antibody of neonate and IgG of gravidas on the development of HDN. Method:The valences of IgG antibody in 652 gravidas were tested by MGIA when ABO blood type was incompatible between husband and wife, and the valences of IgG1, IgG2, IgG3 and IgG4 of 25 neonates with HDN were tested by ITA. Result:The positive percent of IgG anti A (B) and Rh (D) negative percent were 33.4% and 0% in gravidas when ABO blood type was incompatible between husband and wife, respectively. In 218 gravidas whose IgG anti A (B) was positive, IgG anti A (B) of 201 gravidas were inherited from the husband, IgG anti A (B) of 17 showed no relationship with the husband, and 25 neonates developed HDN. The detection rate of sub-IgG antibody in neonate with HDN was IgG1(100%)>IgG3(80.0%) >IgG2(44.0%)>IgG4(4.0%). Conclusion:The magnitude of valence of IgG blood type antibody is positive correlation to incidence of HDN when ABO blood was incompatible between husband and wife. IgG1 and IgG3 are the main subtypes of antibody in HDN. In most cases, the collaboration of IgG1 and IgG3 could induce HDN.