O型血孕妇免疫性抗体效价与新生儿溶血病的关系分析

Relationship between immune antibody titer and hemolytic disease of newborn in pregnant women with O blood group

目的分析O型血孕妇免疫性抗体(IgG抗体)效价与新生儿溶血病(HDN)发病率及溶血程度的关系。方法使用微柱凝胶法检测蚌埠市第一人民医院512例O型孕妇产前IgG抗体效价,产后收集新生儿静脉血采用微柱凝胶卡式法和全自动生化分析仪检测新生儿的溶血三项和血清总胆红素,分析IgG抗体效价与HDN发病率及溶血程度的关系。结果免疫性抗体孕妇的HDN总发病率为15.6%(80/512);孕妇IgG抗体效价为1∶64、1∶128、1∶256、1∶512时,HDN的发病率分别为14.0%(12/86)、22.6%(14/62)、34.2%(26/76)、43.8%(28/64),与正常抗体效价组相比(<1∶64),差异均有统计学意义(P<0.005),其血清总胆红素虽有升高,但各组间差异无统计学意义(P>0.05)。孕妇免疫性抗体效价与HDN发病率呈正相关,但与HDN溶血程度无相关。结论孕妇产前免疫性抗体效价检测可预估新生儿溶血病(HDN)发生率,免疫性抗体效价异常的孕妇应及早干预治疗,有助于降低新生儿发生HDN的风险。

Objective To investigate the relationships between the immune antibody （IgG antibody） titer and the incidence and degree of hemolysis of hemolytic disease of newborn in pregnant women with O blood group. Methods The IgG antibody titer was detected by using microcolumn gel assay in 512 pregnant women with O blood group before the delivery. Direct Coombs, free antibody and antibody elution tests, total bilirubin were detected by microcolumn gel assay and automatic biochemical analyzer. The relation between IgG antibody titer and the incidence and degree of hemolysis of hemolytic disease of newborn was analyzed. Results The total incidence rate of HDN was 15.6% in pregnant women with O blood group containing immune antibodies. When the antibody titer Was 1 ： 64,1 ： 128,1 ： 256 and 1 ： 512, the incidence rate of HDN was 14.0% （ 12/86）, 22.6% （ 14/62）, 34.2% （26/76） ,43.8 % （ 28/64）, respectively, the difference was significant as compared with the normal titer group（less than 1： 64）,P〈O. 05. The total serum bilirubin of infants with HDN rose not significantly,but no significant differences was found（ P 〉 O. 05 ）. A positive correlation was existence between IgG antibody titer and the incidence of HDN, but not with the degree of hemolysis. Conclusion Detection of IgG antibody titer can be used to estimate the incidence of hemolytic disease of newborn. For the pregnant women with an abnormal titer level, the early intervention should be performed to decrease the risk of HDN.