无创胎儿血型产前诊断在ABO溶血病早期诊断中的意义

A study on the noninvasive prenatal diagnosis of fetal blood type by maternal blood

目的探讨胎儿血型产前诊断在早期诊断ABO-新生儿溶血病(HDN)中的价值,为早期发现ABO-HDN提供依据。方法回顾性分析2013—2014年在湖州市妇幼保健院产前检查的3 777名O型血孕妇血清Ig G抗A抗B效价检测情况及妊娠结局,利用孕妇外周血中的胎儿DNA检测胎儿ABO血型,并评价其在早期诊断ABO-HDN中的应用价值。结果 3 777名O型血孕妇血清Ig G抗A抗B效价检测结果显示,ABO-HDN高风险孕妇1 175人,占31.10%,低风险孕妇2 602人,占68.90%。对其中769名高风险孕妇进行妊娠结局新生儿情况随访,胎儿血型与孕妇抗A或抗B相对应的641人,占83.36%;不相对应的128人,占16.64%。对其中新生儿血型与抗体检测相对应的高风险孕妇ABO-HDN发病率分析结果显示,抗体效价越高,ABO-HDN发生率越高(χ2趋势=23.752,P<0.01)。从血清Ig G抗A抗B效价≥1∶256的孕妇中随机选择30人,提取孕妇外周血血浆中胎儿游离DNA,利用聚合酶链反应-序列特异性引物分型检测胎儿ABO血型基因型,与胎儿出生后血型一致率为100%。结论孕妇血清Ig G抗A抗B效价检测结果在ABO-HDN产前预防中存在干扰因素,仅凭其效价高低进行ABO-HDN的早期诊断和治疗具有一定的局限性;胎儿血型产前诊断技术作为辅助诊疗手段早期诊断ABO-HDN时可有效提高诊疗水平。

Objective ToexplorethevalueofprenataldiagnosisoffetalABObloodgroupsinthepreventionofABO-HDN,andtoprovideevidenceforpreventionofABO-HDN.Methods Atotalof3777sampleswerecollectedfromthe pregnant women whose ABO blood group is O,and we detected the ABO blood group by serological method to detect the titerofIgGanti-Aandanti-Binthematernalblood.Results Amongthe3777samplescollectedfromthepregnant women whose ABO blood group is O ,the titer of IgG anti-A to anti-B was 1 to1 024 in 27 samples(0.7%),1∶51 2 in 97 samples(2.6%),1∶256 in 1 63 samples(4.3%),1∶1 28 in 285 samples(7.5%)and 1:64 in 603 samples(1 6%). We followed the pregnancy and newborn outcome of 769 case whose antibody titer of 1∶64 or more ,and compared the fetal ABO blood group with results of the titer of IgG anti -A and/or anti -B.A total of 641 patients (83.3%) was corresponding resistance against A or B,and 1 28 patients (1 6.6%)was not corresponding resistance against A or B.The higher the antibody titer,the higher incidence of neonatal ABO hemolytic disease occurred.We extracted the fetal free DNA of peripheral blood plasma in 30 pregnant women, and the genotypes of fetal ABO blood group were detected by the polymerase chain reaction-sequence specific primer (PCR-SSP),and all the experiment presented success.Conclusion ThetiterofIgGanti-Atoanti-Bcouldbeusedtopreventtheoccurrenceofhemolyticdiseaseofnewborn. Considering the interference factors,the fetal free DNA in the maternal circulation could be used to prenatally detect fetal ABO blood groups.