新生儿ABO型溶血应用大剂量静脉丙种球蛋白治疗导致坏死性小肠结肠炎的调查研究

Neonatal ABO hemolytic lead to necrotizing enterocolitis with gammaglobulin in survey research

目的分析调查新生儿ABO溶血病应用大剂量静脉注射丙种球蛋白（IVIG）导致坏死性小肠结肠炎（NEC）的发生情况以及发生NEC的危险因素。方法选取2011~2013年收治的所有ABO型溶血患儿。根据研究对象是否应用IVIG分为未使用IVIG组1 240例和使用IVIG组380例。收集患儿一般人口学特征。将是否使用IVIG、是否为早产儿（SGA）、性别、胎盘早破、母亲糖尿病等作为自变量,以是否发生了NEC为其应变量进行多因素Logistic回归分析。比较两组患儿治疗前血清胆红素含量、黄疸消退时间以及NEC发生率。结果患儿治疗前血清胆红素含量与黄疸消退时间的比较发现,使用IVIG组的患者治疗前的血清胆红素含量高于未使用IVIG组,且在治疗后黄疸的消退时间少于未使用IVIG组,两组比较差异具有统计学意义。使用IVIG组NEC的发生率高于未使用IVIG组,差异有统计学意义（P〈0.05）。多因素Logistic回归分析,结果发现使用IVIG、SGA和Apgar评分低是ABO型溶血患儿发生NEC的高风险因子。结论 IVIG在新生儿的ABO型溶血病治疗中获得了积极的疗效,但仍要注意相应适应证、输注后反应及输注速度,使NEC发生率降到最低。

Objective To discuss the application of large dose of gamma globulin in the incidence of neerotizing enterocolitis in our hospi- tal neonatal ABO hemolytic disease and the risk of enterocolitis pointer, for later to provide scientific basis for clinical prevention and therapy. Methods Select all ABO hemolytic children between 2011 and 2013, who admitted to our hospital. According to whether or not checking IVIG, ABO hemolytic children can be divided into using of IVIG group （ 1240 patients） and not using of IVIG group （380 patients）. The demographic characteristics of all children was collected. We analyzed these related factors, including whether to use IVIG, whether preterm children （SGA） , gender, premature rupture of the placenta, maternal diabetes, etc. These factors were included as independent variables, whether there has been NEC multivariate logistic regression analysis for the dependent variable. The serum bilirubin, jaundice time and the incidence of NEC were com- pared of two groups of children before treatment. Results The serum bilirnbin, jaundice time, serum bilirubin in children before treatment IVIG group were higher than those without the use of IVIG group. The jaundice subsided less than in the control group, The difference was statistically significant. NEC using IVIG group was higher than not using IVIG group, the difference was statistically significant （ P 〈 0.05 ）. Multivariate lo- gistic regression analysis found that the use of IVIG, SGA and low Apgar scores was ABO hemolytic occurs in children at high risk factor of NEC. Conclusion Although IVIG in the treatment of type ABO hemolytic disease of newborn obtained the certain effect, but still need to pay attention to the corresponding indication, infusion speed and reaction ＇after the infusion, so as to minimize the incidence of NEC.