天津地区RhD阴性孕妇胎母出血的研究

Fetomaternal hemorrhage in RhD-negative pregnant women in Tianjin

目的本研究拟对天津地区RhD阴性孕妇胎母出血(FMH)情况进行研究监测,从中获得此类人群的FMH数据;并分析其与年龄、血型、孕龄、产后新生儿溶血病发生等之间的关系。方法用FITC-抗HbF单克隆抗体流式细胞术检测孕妇FMH含量;血型血清学方法检测血型,盐水法和间接抗人球法进行不规则抗体鉴定;溶血三项试验检测新生儿溶血。结果86例RhD阴性孕妇FMH量在0~11.48ml之间,均值为1.82ml。63.95%孕妇FMH量<2ml,23.26%孕妇FMH量在2~4ml之间,11.63%孕妇FMH量在4~10ml之间,1.16%的孕妇FMH量超过10ml。≤30岁孕妇比>30岁孕妇的低出血量所占比例高11.71%,其差异无统计学意义(P>0.05)。孕妇O型,A型,B型和AB型中,FMH量并无显著变化。夫妻ABO同型血型孕妇比异型孕妇的高出血量比例低12.46%,其差异无统计学意义(P>0.05)。孕龄在28~32周孕妇的FMH高出血量比例高于≤28孕周者14.55%,并高于>32孕周者35.32%,其差异具有统计学意义(P<0.05)。86例样本中有3例检出抗D抗体阳性,产后溶血检测患儿溶血三项试验均为强阳性,效价在1∶2~1∶32之间,FMH量在1.50~6.93ml之间。10例无产后溶血症发生的孕妇FMH低出血量比例比5例有溶血症者高70%,其差异无统计学意义(P>0.05)。结论本研究提示流式细胞术监测FMH含量能反应Rh阴性孕妇FMH情况,FMH范围,与年龄、血型、孕周、产后溶血发生的关系这一系列研究结果可为推动我国大陆开展孕妇抗D球蛋白的规范使用提供实验数据基础。

Objective To study and monitor the situation of femomaternal hemorrhage (FMH) in RhD- negative pregnant women in Tianjin,obtain the FMH data of such population,and analyze the relationship between FMH and age,blood type,gestational age,hemolytic disease of postpartum neonates,etc. Methods The FMH level was detected by flow cytometry with FITC-anti-HbF monoclonal antibody. The blood type was detected by blood serum method. The irregular antibody was identified by saline method and indirect anti-human ball method. The hemolysis of postpartum neonates was detected by three tests of hemolysis. Results The FMH volume of 86 RhD negative pregnant women was between 0 and 11.48 ml,with an average of 1.82 ml. There were 63.95% of pregnant women showed a volume of FMH<2.0 ml,23.26% between 2 and 4 ml,11.63% between 4.0 and 10.0 ml,and 1.16%> 10 ml. The proportion of lower FMH in pregnant women ≤30 years old was >11.71% higher than that in the pregnant women >30 years old,but the difference was no statistical significant. There was no significant difference in FMH of pregnant women with O,A,B and AB types. The proportion of higher FMH in pregnant women with compatible ABO blood type with her husband was 12.46% lower than that of the heterozygous cases,but the difference was no statistical significant. The proportion of higher FMH in the pregnant women with 28 to 32 weeks gestational age was 14.55% higher than that of ≤28 weeks and was 35.32% higher than that of >32 weeks,and the differences were statistical significant. Three samples in the 86 samples were positive for anti-D antibody,and their three hemolytic test results were strongly positive with the anti-D titer from 1:2 to 1:32 and the FMH volume from 1.50 to 6.93 ml. The proportion of lower FMH in the 10 pregnant women without postpartum hemolysis was 70% higher than that in 5 pregnant women with postpartum hemolysis,but the differences were not statistical significant. Conclusions The results suggest that monitoring FMH content by flow cytometry can reflect FMH in Rh-negative pregnant women. The studies on the relationship between FMH and age,blood type,pregnant time and hemolytic disease of postpartum neonates can provide basically experimental data for standard use of anti-D immunoglobulin in pregnant women.