3256例高胆红素血症新生儿溶血病血清学检测结果分析

Analysis of serological test results of hemolytic disease of newborn from 3256 cases of hyperbilirubinemia

目的:分析新生儿溶血病(HDN)血清学检测结果,探讨其与不同血型、性别及患儿年龄等因素的关系,为HDN的临床诊断和治疗提供帮助。方法:对3 256例高胆红素血症新生儿进行血型鉴定、不规则抗体筛查、HDN血清学检测(溶血3项)并同时鉴定患儿母亲血型。结果:3 256例高胆红素血症新生儿中,确诊HDN患儿928例,阳性率为28.5%,其中ABO-HDN 889例(95.8%)、Rh-HDN 39例(4.2%);A、B、AB血型患儿ABO-HDN阳性率分别为52.8%、42.1%、0.9%,ABO-HDN的发生率与新生儿血型的比较差异有统计学意义;A、B血型患儿总胆红素水平分别为(313.9±88.1)μmol/L、(342.2±108.8)μmol/L,ABO-HDN发生的严重程度与新生儿血型的比较差异有统计学意义;男、女性患儿ABO-HDN阳性率分别为54.1%、45.9%,差异有统计学意义;在ABO-HDN中年龄≤5d患儿检出率高于年龄>5d患儿;ABO-HDN直接抗人球蛋白试验(直抗)、游离抗体试验(游离)、抗体释放试验(放散)3项试验阳性率分别为34.9%,79.0%,100.0%,差异有统计学意义。结论:HDN绝大多数由ABO血型不合引起并以男性患儿居多,其中又主要出现在A型血患儿身上,但B型患儿发生的严重程度更高。放散试验比直抗试验及游离试验诊断HDN的准确率高,而且送检越早,阳性检出率越高。

Objective：To analyze the serological test results of hemolytic disease of newborn and explore the relationship between serological results and related factors such as the newborn blood type,gender and age as well as research the laboratory basis for diagnosis and treatment for hemolytic disease of newborn.Method：3 256 neonatal with high blood bilirubin were selected,blood type,irregular antibody screening,serological test results of hemolytic disease of newborn（hemolytic three tests）were conducted.Result：928 cases were diagnosed as hemolytic disease of newborn（HDN）in 3 256 cases of hyperbilirubinemia,the positive rate was 28.5%,among them ABO-HDN were889 cases,accounting for 95.8%,Rh-HDN were 39 cases,accounting for 4.2%;the ABO-HDN positive rate were52.8%,42.1%,0.9% of newborn with A,B and AB blood type,the difference of the incidence of ABO-HDN and the comparison of newborn blood type was statistically significant;the total bilirubin levels of A,and B blood type were（313.9±88.1）μmol/L and（342.2±108.8）μmol/L,the difference of severity of ABO-HDN and newborn blood type was statistically significant,the ABO-HDN positive rate were of male,female newborn were 54.1%,45.9%,the difference was statistically significant;the ABO-HDN positive rate of newborn with age≤5 days newborn was higher than that of newborn with age〉5 days;the ABO-HDN positive rate of direct antiglobulin test（direct antiglobulin）,free antibody test（free）and antibody release test（bleeding）were 34.9%,79.0%,100.0%,the difference was statistically significant.Conclusion：Neonatal hemolysis mostly caused by ABO blood incompatibility,and mostly appear in the male and newborn of blood type A.But the severity of children with type B is higher.The accuracy of antibody release test would be higher than that of direct antiglobulin test and free antibody test for the diagnosis of HDN and The earlier inspection is the higher the positive detection rate is.