母婴血型不合致新生儿溶血病的血型分布

Blood Group Distribution of Hemolytic Disease of the Newborn Caused by Maternal and Infant Blood Group Incompatibility

目的探讨母婴血型不合致新生儿溶血病的血型分布及溶血三项试验在诊断中的价值。方法随机选取2013 年1 月—2018 年11 月兰州市第二人民医院临床送检的262 例高胆红素血症的新生儿血液标本及Rh 阴性或O 型的产妇脐带血标本,用微柱凝胶检测卡进行包括直接抗球蛋白试验、游离抗体试验和抗体释放试验在内的溶血三项试验,并对检测出的结果进行相关统计学分析,探讨其诊断价值。结果在262 例标本中,其中82 例为母婴血型不合,有51 例经检测为新生儿溶血病(HDN)阳性,阳性率高达62.12%。在51 例经检测为HDN 阳性者中,51 例放散抗体试验均为阳性,44 例游离抗体试验阳性,14 例直抗试验阳性。在82 例血型不合的标本中,ABO HDN 阳性率达73.13%;Rh HDN 阳性率达13.33%,经比较差异具有统计学意义(P<0.05)。在67 例ABO 系统不合标本中,其中A 型阳性率达80.65%;B 型阳性率达69.44%,经比较差异具有统计学意义(P<0.05)。在15 例Rh 系统不合标本中,Rh C 均为HDN 阴性;Rh D 阳性率达14.28%,Rh E 阳性率达20.00%。经比较,三者阳性率差异均具有统计学意义(P<0.05)。结论在溶血三项试验中,敏感度最高的是抗体释放试验,可为临床上新生儿溶血的判定提供有力依据。在新生儿溶血病中,最常见的是由于母婴ABO 血型不合而引起的,其发生概率明显高于Rh不合,Rh D 不合引起的溶血发生概率较Rh C 以及Rh E 高,而A 型血患儿则较B 型血患儿发生溶血的概率高。

OBJECTIVE To analyze the blood pressure distribution and three serological test results of neonatal hemolytic disease in diagnosis. METHODS Hemolysis trials of type O or Rh negative maternal cord blood samples and hyperbilirubinemia of the newborn blood samples from January 2013 to November 2018were detected by micro-column gel test cards. Then the results were statistically analyzed. RESULTS There were 82 cases of Maternal and neonatal blood type incompatibility in all 262 cases. 51cases were detected HDN positive with the rate of 62.12%. The positive rate of direct anti-globulin test, free antibody test and antibody released test were 27.45%, 86.27% and 100%. There were statistical difference of HDN positive rate between ABO 73.13% and Rh 13.33% in 82 cases of blood type incompatibility. There was statistical difference between A positive rate(80.65%)and B positive rate(69.44%)in 67 cases of ABO incompatibility. There were statistical difference among Rh D positive rate(14.28%),Rh E positive rate(20.00%)and Rh C positive rate(0). CONCLUSION Antibody released test was the most sensitive test in hemolysis three trials to diagnose HDN positive the probability of HDN positive caused by maternal and neonatal ABO blood type incompatibility was significantly higher than Rh. The probability of HDN positive with type A newborns was significantly higher than type B. The probability of HDN positive caused by Rh D blood type incompatibility was significantly higher than Rh E and Rh C.