178例新生儿溶血病血型分布及血清学检测结果分析

Analysis of serologic detection results and blood group distribution in 178 cases hemolytic disease of newborn

目的研究沈阳市儿童医院178例母婴ABO血型不合引起的新生儿溶血病（HDN）的血型分布规律以及溶血3项的检测结果分析，同时观察新生儿溶血3项试验结果与新生儿出生时间的关系。方法选择近2年在沈阳市儿童医院住院的临床表现符合新HDN的患儿178例，进行ABO和Rh血型鉴定以及新生儿溶血3项试验（包括直接抗人球蛋白试验、红细胞抗体释放试验、血清游离抗体试验），数据分析采用SPSSl7．0统计软件。结果在178例HDN标本中174例为AB0溶血病占97．8％，4例为Rh溶血病占2．2％。在174例AB0溶血病患儿中血清学检测总阳性率为31．6％（55／174），其中A型有77例，阳性率为37．7％（29／77），B型有97例，阳性率为26．8％（26／97），A型和B型阳性率差异无显著性（P〉0．05）。174例ABO溶血病患儿出生后0～2天组阳性率为52．2％，出生后3天组阳性率为37．7％，出生后4天组阳性率为18．2％，出生后5天组阳性率为18．2％，出生后〉5天组阳性率为15．4％。出生日龄≤3天组比〉3天组阳性率显著升高，差异有显著性（Pd0．05）。结论本研究调查的沈阳地区的HDN以AB0一HDN最为常见。A血型和B血型的分布无差异。溶血3项试验在患儿出生后头3天内阳性率最高，此后随着出生日龄的增加，阳性率逐渐降低。

Objective To investigate the blood group distribution of 178 cases hemolytic disease of the newborn （HDN） diagnosed in shenyang children＇s hospitol,and observe the relationship between serologic detection results of hemolysis three tests with neonatal birth time. Methods 178 cases,came from shenyang children＇s hospitol in recent 2 years , had clinical manifestations with HDN. Each case was identified ABO and RH blood group,and detected hemolysis three tests （ including direct coombs test, RBC antibody release test, Serum free antibody test）. Results were analyzed by SPSS 17.0 statistical software. Results Of 178 newborn samples , 174 cases（97.8% ）were ABO- HDN and 4 cases（2.2% ） RH-HDN. The positive rate was 31.6%（55/174）in the 174 cases,including 77 cases of type A 37.7 % （29/77）and 97 cases of type B 26.8 % （26/97）and the difference between them was not statistically significant（ P 〉0.05）. In the 174 ABO-HDN cases,the positive rates of 0-2 days after birth group, 3 days after birth group,4 days after birth group, 5 days after birth group and over 5 days after birth group were 52. 2%, 37.7%,18.2%, 18.2% and 15.4% respectively, the first two group had higher positive rate then the last three groups （ P d0.05）. Conclusion In shenyang,ABO-HDN was the most common HDN ,and the blood type distri- bution difference was not significant. HDN had a high positive rate in hemolysis three tests during the fiist 3 days of newborn and thereafter the positive detection rate would be decreased significantly.