茵栀黄口服液联合血浆置换早期干预治疗母婴血型不合新生儿溶血病

Clinical study of the early interventions of yinzhihuang oral liquid combined with plasma replacement on maternal-fetal blood group incompatibility hemolytic disease of the new born

目的观察茵栀黄口服液联合血浆置换治疗高效价血型抗体孕妇的疗效和安全性，评价茵栀黄口服液用于降低夫妇抗体效价、早期干预治疗母婴血型不合新生儿溶血病的作用机制。方法选择2009年6月-2011年12月于我院检查的高效价孕妇86例，将ABO抗体效价〉1256，Rh／〉64孕妇按自愿原则分成治疗I组、治疗Ⅱ组和对照组。对照组VC3g，VE100mgq．d，吸氧b．i．d，每次20—30min，每月治疗20d；治疗I组在对照组的基础上服用茵栀黄口服液20mlM次，t．i．d，治疗Ⅱ组在I组的基础上同时联合血浆置换治疗，每隔10d做1次，每月检测抗体效价、血生化及B超监测胎儿发育情况，直至分娩，观察3组孕妇抗体效价平均下降幅度和时间，产后新生儿的情况。结果治疗组总有效率和抗体下降时间与对照组相比，差异有统计学意义（P〈0．05），治疗I组总有效率（23／32，71．88％）低于治疗Ⅱ组（29／31，93．55％），抗体效价降低时间长于治疗Ⅱ组P〈0．05。结论ABO抗体效价≤512，Rh≤64，仅需服用茵栀黄口服液即可，但ABO抗体效价≥1024，Rh≥128，需要在服药的基础上联合血浆置换等进行综合治疗。茵栀黄口服液用于孕期降低血型抗体效价，早期干预治疗母婴血型不合新生儿溶血病具有很好的效果，对孕妇和胎儿是安全的，对于高效价孕妇联合血浆置换治疗效果更好，值得临床推广应用。

Objective To assess the efficacy and safety of early interventions by yinzhihuang oral liquid combinewith plasma replacement in treatment of hemolytic disease of the new- born （HDN）. Methods From Jun. 2009 to Dec. 2011 in our hospital ,86 cases of high antibody titer pregnant women （ABO ≥256, Rh ≥6,4）were randomly divided into treatment group Ⅰ （32 cases） ,treatment group Ⅱ （31 cases） and control group（23 cases）. The control group were given Vc 3g,VE 100 mg q. d,oxygenuptake bid. 20 -30min at a time,therapy 20 d every month. The treatment group I were given yinzhihuang oral liq- uid treatment base on the control ~oup ,20 mL tid. The treatment group Ⅱ combined yinzhihuang oral liquid with plasma re- placement semimonthly. The mean serum antibody tiler,blood and the states of foetus intrauterine growth were compared and analyzed. Results The total effective rate and the decrease of antibody titer in treatment groups was better than that of the control group,there was significant differences between two treatment groups（P 〈 0. 05）. Conclusion Yinzhihuang oral liq- uid can cure when the antibody liter lower （ABO≤512, Rh ≤64 ） , but it was necessary that yinzhihuang oral liquid combined with plasma replacement when the antibody titer higher （ABO ≥ 1 024, Rh ≥128 ）. Yinzhihuang oral liquid is safe and effective drug for early interventions in treatment of blood type incompatible HDN. The therapeutic efficacy is evident and safe to the pregnant women and foetus. If combined with plasma replacement, herbal medicine has the advantage of faster efficacy and less side effects, and is superior to herbalmedicine. It would be a new operation to early intervention of HDN.