新生儿 ABO 血型不合溶血病临床及实验室结果分析研究

Clinical and Experimental Analysis about ABO Hemolytic Disease of the Newborn in Qingdao

目的：探讨新生儿 ABO 血型不合溶血病的临床与主要实验室特征。方法收集青岛市妇女儿童医院2013年6月～2015年2月收治的422例新生儿 ABO 溶血病病例，应用微柱凝胶技术并结合胆红素及网织红细胞指标对其进行系统分析。结果422例患儿中第一胎388例，其中 A 型为206例，B 型为216例，两者差异无统计学意义（χ2＝0.24，P ＞0.05）。男性218例，女性204例，两者差异无统计学意义（χ2＝0.46，P ＞0.05）。胆红素均以间接胆红素升高为主，总胆红素峰值在116～465μmol／L 之间，尤以256.5～342.0μmol／L 居多，占38.9％（χ2＝142.41，P ＜0.05）。162例患儿网织红细胞计数升高，占38.5％（χ2＝75.62，P ＜0.05）。溶血三项试验结果多为游离和放散试验同时阳性，占80.1％（χ2＝146.98，P ＜0.05）。结论新生儿 ABO 溶血病第一胎即可发病，溶血三项试验以游离和放散试验同时阳性居多。三项实验均阳性的患儿更易发生高胆红素血症。早发现、早治疗是防治该病，减少胆红素脑病的关键所在。

Objective To investigate the clinical and laboratory feature of neonatal hemolytic disease （HDN）occurred in Qingdao caused by mother-baby ABO blood type disagreement.Methods Serum bilirubin （TBIL）test and micro column gel technology were used on 422 cases neonatal hemolytic disease children blood samples （collected from Jun.2013 to Feb.2015）.Results There were 388 cases first-born children among 422 cases including 206 cases of type A and 216 of type B and the difference between them was not statistically significant （χ2 =0.24,P 〉0.05）.The difference between male （218 cases）and female （204 cases）was not statistically significant （χ2 =0.24,P 〉0.05）too.The indirect bilirubin （IBI）increas-ing was more obviously.The peak level of serum bilirubin was 116~465 μmol/L and 256.5~342.0 μmol/L was 38.9% （χ2=0.24,P 〉0.05）.162 cases reticulocyte count was increased nearly 38.5% （χ2 =75.62,P 〈0.05）.RBC antibody release test and serum free antibody test were often positive and the percentage was 80.1% （χ2 =146.98,P 〈0.05）.Conclusion The neonatal hemolytic disease may turn up in first-born children.The child with three positive test was more sensitive to neonatal hyperbilirubinemia.RBC antibody release test and serum free antibody test are often positive.It is important to make the early diagnosis and treatment as soon as possible for reducing the bilirubin encephalopathy.