脐带血早期诊断新生儿ABO溶血病对预防严重高胆红素血症的价值

Values of early diagnosis of neonatal ABO hemolytic disease with cord blood to prevent severe hyperbilirubinemia

目的探讨出生时采用脐带血直接抗人球蛋白试验(DAT)及抗体释放试验早期诊断新生儿ABO溶血病,对预防严重高胆红素血症的价值。方法选择2013年6月至2016年6月,于四川大学华西第二医院新生儿科确诊为ABO溶血病的655例晚期早产儿及足月新生儿为研究对象。其中,出生时经脐带血DAT及抗体释放试验确诊为ABO溶血病的188例患儿纳入研究组,入院后经静脉血DAT及抗体释放试验确诊为ABO溶血病的467例患儿纳入对照组。回顾性分析2组患儿的临床病例资料,并采用t检验或χ~2检验,对2组患儿的一般临床资料、主要实验室检查结果、治疗及近期预后等,进行统计学比较。本研究与所有患儿监护人均签署知情同意书。结果 (1)研究组患儿入院年龄及发现黄疸时年龄,均小于对照组[(34.3±21.8)h vs(58.8±34.3)h,(22.0±12.8)h vs(32.3±19.0)h],入院时血清总胆红素(TSB)浓度及血红蛋白(Hb)水平,均低于对照组[(185.5±49.2)μmol/L vs(243.3±85.1)μmol/L,(147.3±21.6)g/L vs(153.8±24.9)g/L],剖宫产比例高于对照组(70.2%vs 56.5%),并且上述临床指标比较,差异均有统计学意义(t=9.071,P<0.001;t=6.831,P<0.001;t=8.743,P<0.001;t=3.132,P=0.002;χ~2=10.492,P=0.001)。(2)研究组患儿换血率及白蛋白使用率均低于对照组(0vs 9.0%,9.6%vs 22.5%),并且差异均有统计学意义(χ~2=18.532,P<0.001;χ~2=15.151,P<0.001)。(3)7例发生胆红素脑病患儿,均为对照组患儿。结论出生时采用脐带血DAT及抗体释放试验筛查ABO溶血病,可使医师和监护人对ABO溶血病患儿的黄疸加强监测,有助于早期发现需要住院光疗的患儿,避免发生需要采取换血治疗的严重高胆红素血症和胆红素脑病。

Objective To explore the values of prevention of severe hyperbilirubinemia through early diagnosis of neonatal ABO hemolytic disease by cord blood direct antiglobulin test（DAT）and antibody release test.Methods A total of 655 late preterm and full term infants were chosen as study subjects.They were diagnosed as ABO hemolytic disease from June 2013 to June 2016 in Department of Neonatology in West China Second University Hospital,Sichuan University.A total of 188 cases of ABO hemolytic disease neonates who were diagnosed with cord blood DAT and antibody release test at birth were assigned into observation group,and 467 ABO hemolytic disease neonates who were diagnosed with venous blood DAT and antibody release test after admitted to hospital were assigned into control group.Case informations of two groups were retrospectively analyzed.The general clinical data,main indexes of laboratory examination results,treatments,and short term prognosis were statistically compared between two groups by t test or chi-square test.All guardians of research subjects signed the informed consents.Results（1）The age of admission to hospital and discovery of jaundice in observation group were all younger than those in control group [（34.3±21.8）h vs（58.8±34.3）h,（22.0±12.8）h vs（32.3±19.0）h,respectively],the levels of total serum bilirubin（TSB）and hemoglobin（Hb）in observation group were lower than those in control group[（185.5±49.2）μmol/L vs（243.3±85.1）μmol/L,（147.3±21.6）g/Lvs（153.8±24.9）g/L,respectively],proportion of cesarean section in observation group was higher than that in control group（70.2% vs56.5%）,and all the differences above were statistically significant（t=9.071,P〈0.001;t=6.831,P〈0.001;t=8.743,P〈0.001;t=3.132,P=0.002;χ~2=10.492,P=0.001）.（2）The blood exchange transfusion rates and albumin usage rates in observation group were all lower than those in control group（0 vs 9.0%,9.6% vs 22.5%,respectively）,and the differences were statistically significant（χ~2=18.532,P〈0.001;χ~2=15.151,P〈0.001）.（3）A total of 7 neonates with bilirubin encephalopathy were all in control group.Conclusions Screening ABO hemolytic disease by cord blood DAT and antibody release test at birth can strengthen physicians and guardians′awareness of jaundice monitoring of neonatal ABO hemolytic disease,and to find out the infants who need phototherapy,to avoid severe hyperbilirubinemia and bilirubin encephalopathy which need blood exchange transfusion therapy.