脐血胆红素和溶血3项对早期诊断新生儿ABO溶血病的价值

The value of umbilical cord blood bilirubin and hemolysis three test in the early diagnosis of neonatal ABO hemolytic disease

目的:探讨脐血胆红素浓度、溶血3项在早期诊断新生儿ABO溶血病、高胆红素血症中的应用价值。方法:回顾性分析1 112例新生儿脐血胆红素浓度、溶血3项结果,根据母婴血型、溶血3项结果、脐血胆红素浓度分组分析。结果:①母婴O-A/B血型不同组脐血胆红素、游离抗体试验、抗体释放试验阳性率、HDN发生率及新生儿高胆红素血症发生率均明显高于母婴O-O血型相同组。②抗体释放试验阳性组脐血胆红素浓度及高胆红素血症发生率明显高于抗体释放试验阴性组。③脐血胆红素浓度越高,新生儿高胆红素血症发生率越高,阳性预测值越高;当脐血胆红素>55μmol/L时新生儿高胆红素血症发生率最高(92.68%),与各组比较均有统计学意义(P<0.05),阳性预测值达92.68%,特异性达99.66%;④在脐血胆红素0～21μmol/L或>55μmol/L时,抗体释放试验在发生新生儿高胆红素血症的阳性预测值及特异性均为100.00%。结论:检测母婴ABO血型不合新生儿脐血胆红素及溶血3项可早期诊断新生儿ABO溶血病及新生儿高胆红素血症,临床上值得推广应用。

Objective: To study the application value of umbilical cord blood bilirubin and hemolysis three test in the early diagnosis of ABO hemolytic disease of neonatal( ABO- HDN) and hyperbilirubinemia of newborn. Methods: The three hemolytic test and serum total bilirubin in 1 112 newborns were retrospectively analyzed,and grouped according to maternal and child blood type,the three hemolytic test,umbilical cord blood bilirubin concentrations. Results: Concentrations of umbilical cord blood bilirubin,the incidence of HDN,the incidence of hyperbilirubinemia,positive rate of free antibody test,antibody release test in the maternal- fetal blood( O- A / B) group,they were significantly higher than in the maternal blood type( O- O) group; ②Concentrations of umbilical cord blood bilirubin,the incidence of hyperbilirubinemia in the group of antibody release test positive were significantly higher than in the group antibody release test negative; ③When the concentrations of umbilical cord blood bilirubin was higher,the incidence of hyperbilirubinemia was higher and positive predictive value was higher; when the concentrations of umbilical cord blood bilirubin was more 55 μmol / L,the incidence of hyperbilirubinemia was highest( 92. 68%),which compared with other groups were significantly different( P < 0. 05),the positive predictive value was92. 68%,and the specificity was 99. 66%; ④When the concentrations of umbilical cord blood bilirubin was less than 21 μmol / L or more than 55 μmol / L,the positive predictive value and the specificity of hyperbilirubinemia of newborn both were 100% on antibody release test. Conclusion: Detection of umbilical cord blood bilirubin and hemolysis three test in the maternal- fetal blood group incompatibility could diagnose early about ABO- HDN and hyperbilirubinemia of newborn,that should be applied popularly.