早产儿ABO溶血病临床分析

Clinical analysis of preterm infants with ABO incompatibility

目的:探讨早产儿ABO血型不合溶血病的临床特点及严重程度。方法:纳入163例出生胎龄29~35周确诊为ABO溶血病的早产儿为ABO溶血组,另取163例相应胎龄、出生无ABO溶血病的早产儿为对照组。所有早产儿均为2010年1月至2013年12月在川北医学院附属医院新生儿科住院患儿。记录生后10 d内血细胞比容、总胆红素(TBIL)水平、光疗需求以及血型抗体等测定结果。结果:生后10 d内,ABO溶血组与对照组血细胞比容差异无统计学意义(P=0.072);7 d以后TBIL水平(P<0.001)高于对照组,光疗时间长于对照组(P<0.001);住院期间TBIL最高值也较对照组高(P=0.019)。亚组分析显示,出生胎龄在29~31+5周的ABO溶血组早产儿,血细胞比容(P=0.082)及TBIL水平(P=0.090)与对照组相比差异均无统计学意义;出生胎龄在33~35+5周的ABO溶血组早产儿直接抗人球蛋白阳性检出率(P<0.001)、TBIL水平(P<0.001)及光疗时间(P<0.001)均明显高于对照组。结论:随着胎龄的增加,ABO溶血病早产儿直接抗人球蛋白阳性检出率及新生儿黄疸发生率增加。

Objective:To evaluate the clinical characteristics and severity of ABO incompatibility hemolytic disease among preterm infants.Methods:Clinical and laboratory data were collected retrospectively from the medical records of 163 ABO-incompatible preterm infants born at gestational age(GA)of 29-35 weeks,as well as 163 controls matched for GA and birth weight.All infants were born at the Affiliated Hospital of North Sichuan Medical College between 2010 and 2013.The results of hematocrit,total bilirubin level,phototherapy requirement and blood group antibody were recorded within 10 days after birth.Results:No differences between the ABOincompatible groups and the control groups were recorded during the first 10 days of life regarding hematocrit levels.Total serum bilirubin levels and phototherapy hours were higher among the ABO-incompatible group after the first 7 days of life.Upon evaluating subgroups divided by GA,we found no differences on any hematological and jaundice factors among preterm infants of 29-31+5 weeks,whereas among preterm infants of 32-35+5 weeks,the higher positive direct antiglobulin test(DAT)results,the higher total serum bilirubin levels as well as higher phototherapy hours were documented.Conclusion:With increasing GA,more positive DAT results and greater incidence of neonatal jaundice were occurred among ABO-incompatible preterm infants.