血型及首次出现黄疸时间与新生儿ABO溶血病的相关性

The relationship among the newborn's blood type,the first appearance of jaundice time and the severity of neonatal ABO hemolytic disease

目的探讨患儿血型及首次出现黄疸时间与新生儿ABO溶血病的相关性和新生儿ABO溶血病的临床特点。方法选取2013年5月-2015年6月在宜宾市第一人民医院新生儿科符合入选标准的新生儿ABO溶血病108例进行回顾性分析,根据患儿血型分为A型血组51例和B型血组57例两组;根据患儿生后首次出现黄疸时间（first appearance of jaundice time,FAJT）分为早期组（n=34,FAJT≤12h）、中期组（n=48,12h24）3组。比较各组新生儿入院时血清总胆红素（serum total bilirubin,STB）、血红蛋白（hemoglobin,HGB）、网织红细胞百分比（the percentage of reticulocyte,Ret%）、超敏C反应蛋白（Hypersensitive CRP,Hs-CRP）、直接抗人球蛋白实验（Coomb’s实验）、光疗时间、贫血发生率和输血率。结果 A型血组与B型血组比较,Coomb’s实验阳性率差异有统计学意义（P〈0.05）。早期黄疸组分别与中、晚期黄疸组比较,STB、HGB、Ret%和光疗时间差异均有统计学意义（均P〈0.05）;中期黄疸组与晚期组比较,Ret%和光疗时间差异有统计学意义（均P〈0.017）;3组间输血率比较差异有统计学意义（均P〈0.05）。STB与HGB和FAJT分别存在正相关性（r=0.31,rs=0.43,均P〈0.01）;Ret%与HGB和FAJT分别存在负相关性（r=-0.35,rs=-0.56,均P〈0.001）;HGB与FAJT存在正相关性（rs=0.20,P〈0.05）。结论患儿血型与新生儿ABO溶血病的病情严重程度无相关性,生后首次出现黄疸时间与之有关,黄疸出现时间越早,溶血程度和病情越重。

Objective To analyze the clinical characteristics and discuss the relationship among the newborn＇s blood type,the first appearance of jaundice time and the severity of neonatal ABO hemolytic disease.Methods 108 infants with ABO hemolytic disease were retrospectively analyzed.Firstly,they were divided into group A and group B according to the blood type.Secondly,according to the fist appearance of jaundice time,the patients were divided into early group,interim group and later group.The serum total bilirubin,hemoglobin,percentage of reticulocyte,hypersensitive c-reactive protein,direct antiglobulin test,phototherapy time,the incidence rate of anemia and the rate of transfusion were observed.Results The positive rate of direct antiglobulin test had statistical difference between type A and type B blood（P〈0.05）.There were significant difference in serum total bilirubin,hemoglobin,percentage of reticulocyte and phototherapy time among early,interim and later jaundice group（P〈0.05）,and the rate of transfusion was different（P〈0.05）.The first appearance of jaundice time was positively correlated with the serum total bilirubin and hemoglobin respectively and negatively correlated with the percentage of reticulocyte（rs=0.43,0.20,-0.56,P〈0.05）.There was positive correlation between the serum total bilirubin and hemoglobin（r=0.31,P〈0.01）.Conclusion The severity of ABO hemolytic disease has no relevance to the newborn＇s blood type,but is correlated to the first appearance of jaundice time.The earlier the jaundice occurs,the more severe the disease and hemolysis degree.