血清学试验在诊断新生儿ABO溶血病中的意义

Significance of serological test in diagnosis of ABO hemolytic disease of the newborn( ABO- HDN)

目的探讨溶血三项试验和孕妇IgG抗-A(B)效价在新生儿ABO溶血病(ABO-HDN)中的意义。方法对432例新生儿黄疸患儿进行溶血三项试验包括直接抗人球蛋白试验(DAT)、血清游离抗体试验和抗体放散试验,以及进行血清总胆红素测定,并且对孕妇进行IgG抗-A(B)效价测定,将实验结果进行比较分析。结果 432例新生儿黄疸病例中,313例母婴ABO血型不合,ABO-HDN发生率为61.3%(192/313),其中DAT阳性率为42.1%,游离试验阳性率为45.3%,释放试验阳性率为100%,母亲IgG抗-A(B)效价均异常(≥1∶64)。患儿血清总胆红素水平在DAT阴性和阳性组间差异有统计学意义(t=7.35,P<0.01),在释放试验阴性和阳性组间差异无统计学意义(t=0.80,P>0.05),而患儿血清总胆红素水平在母亲IgG抗-A(B)不同效价组间无相关性(F=1.23,P>0.05)。结论溶血三项试验在新生儿ABO-HDN诊断中有重要意义,孕妇IgG抗-A(B)效价有助于预测ABO-HDN的发生。

Objective To discuss the significance of serologic test in prediction and diagnosis of the ABO hemolytic disease of the newborn （ ABO - HDN）. Methods Serological tests including direct anti - human globulin test, free antibody test and an- tibody release test, and serum total bilirubin determination were performed in 432 neonatal jaundice cases. The anti - A（B） IgG antibodies were examined in maternity patients, then the test results of newborns and maternity patients were analyzed. Results In 432 newborns jaundice cases, 313 cases showed incompatibility in ABO blood group with mothers. The incidence rate of ABO - HDN was 61.3% （ 192/313）, among them DAT positive rate was 42.1%, the free antibody test positive rate was 45.3%, antibody release test positive rate was 100%, maternal anti- A（B） IgG antibodies were all abnormal （ 〉 1 ： 64）. The level of serum total bilirubin had no significant statistical differences between DAT positive group and negative group （ t = 7. 35, P 〈 0.01 ）, no statistical differences between positive group and negative group of antibody release test （t = 0. 80, P 〉 0.05 ） and no correlation among maternal groups with different antibody titers （ F = 1.23, P 〉 0.05）. Conclusion Serological hemoly sis tests are important in diagnosis of ABO - HDN. Maternal anti - A（B） IgG antibody titer can help to predict the occurrence of ABO - HDN.