156例新生儿溶血病患儿血清学检测结果及相关因素分析

Analysis of serological test results and related factors of hemolytic disease of newborn in 156 cases

目的分析新生儿溶血病(HDN)患儿血清学检测结果并探讨其与母体孕期血型抗体效价、患儿性别、母婴血型组合、患儿放散液抗体效价等因素的关系。方法对156例患高胆红素血症的新生儿血标本进行血型鉴定和溶血3项试验,放散试验结果阳性标本进一步检测血型抗体效价,同时收集患儿血清胆红素、母体孕期血型抗体效价、母婴血型组合、患儿性别及标本采集时间等数据,然后进行统计学分析。结果(1)156例标本中有89例为ABO-HDN(57.05%),有1例为Rh HDN(0.64%);(2)HDN的发生与母亲孕期抗体效价相关(P<0.01)且抗体效价越高,HDN发生率越高;(3)患儿放散液抗体效价与其血清胆红素水平无相关性(P>0.05);(4)不同母婴血型组合的患儿HDN的发生率差异有统计学意义(P<0.05),O-A型(30.12%)高于O-B型(26.92%);标本采集时间与HDN的检出率密切相关(P<0.01),随着出生时间延长,HDN检出率也随之减低。结论 (1)血清学溶血3项试验中放散试验的灵敏度最高,是实验室判断新生儿溶血病最准确的指标。(2)新生儿溶血病发生率随着孕妇血型抗体效价升高而升高。(3)出生后疑为HDN的新生儿应尽早采集标本送检。

Objective TO anMyze the serologic test results of hemolytic disease of newborn （HDN） and explore the relationship between serological results and related factors such as the maternal blood type antibody titer during pregnancy, sex of newborn, blood type of newborn and antibody titer of elution liquid of newborn. Methods The blood type and hemolysis three trials （direct antiglobulin test （DAT）,i＇ree antibody test and elution test） of 156 newborns with hyperbilirubinemia were detected. The blood type antibody titer of elution ＇liqUid was detected when result of elution test was positive. At the same time, some clinical data of these newborns includingsex, speCimens collecting time and serum bilirubin values were collected. Then all data was statistically an- alyzed. Results （1）There were 89 cases of ABO HDN （57.05%） and 1 case of Rh HDN （0.64%） in all 156 newborns. （2）The occurrence of HDN was correlated with the maternal blood type antibody titer during pregnancy （P%0.01） ,and the higher the an- tibody liter, the more HDN occurred. （3）There was no correlation between antibody titer of elution liquid and serum bilirubin values （P〉0.05）. （4）There was statistical difference of HDN occurrence among different combinations of maternal and neonatal blood group （P〈0.05）, such as type O-A（30.12 %）〉 type O-B（26.92 % ）. Specimen collection time was closely related to the positive rates of HDN detection （P%0.01） ,and with the birth time extended, positive rate of detection was reduced. Conclusion （1） Elu- ti0n test is the most sensitive test in hemolysis three trials and is the most accurate laboratory indicator to diagnose HDN. （2）The occurrence rate of HDN rises when the maternal blood type antibody tiler during pregnancy rises. （3）After the birth, HDN suspec- ted newborns should be collected samples as early as possible.