孕妇血型抗体与新生儿溶血病的血清检查研究

Study on Serum Examination of Maternal Blood Group Antibody and Hemolytic Disease of Newborn

目的研究孕妇血型抗体与新生儿溶血病(HDN)的关系。方法选取2016年8月至2018年7月兰州市西固区人民医院接受分娩的500例孕妇中,选取夫妻血型不合的420例。对这420例孕妇产前予以血型血清学的检查,检查项目包括孕妇ABO的正反定型;IgG抗A(B)抗体的效价试验;Rh(D)的定型;不规则抗体的筛查;抗体的特异性以及效价的测定。对孕妇分娩的124例新生儿应用HDN的确定试验,试验内容包括:测定血清的胆红素、游离抗体的试验、抗体的释放试验;红细胞直接抗人球蛋白的试验;新生儿ABO及Rh(D)定型。结果420例孕妇中413例存在ABO血型不合者,占总数的98.33%,10例Rh(D)不合格者,3例Rh(D)与ABO同时不合者。413例血型不合的产妇中,阳性IgG抗-A(B)效价大于64者170例(41.16%);O型孕妇抗体的阳性率与A、B型对比存在差异(P<0.05)。413例孕妇经不规则抗体的筛查,结果阳性者10例(2.42%),经过抗体的特异性鉴定,确为Rh系统的IgG抗体,效价为7~255。124例新生儿中34例(27.42%)被确诊为HDN,其中31例为ABO-HDN,3例为Rh-HDN;分别对比孕妇IgG抗-A(B)效价,高、中、低值组对比存在差异(P<0.05);3例的Rh-HDN分别由抗-D、抗–E、抗-C引起,各占总数的1/3。结论O型孕妇较A、B型更易引发ABO-HDN,而且其发病率依据母体内IgG抗体的效价升高而随之升高;Rh系统的不规则抗体更易引发Rh-HDN,与不良妊娠以及孕妇的输血史关系密切。

Objective To study the relationship between blood group antibody of pregnant women and hemolytic disease of newborn(HDN).Methods From August 2016 to July 2018,420 of the 500 pregnant women who were delivered in our hospital were selected for their blood group incompatibility.These 420 pregnant women were examined by blood group serology before delivery,including the ABO positive and negative stereotypes,the titer test of IgG anti-A(B)antibody,Rh(D)typing,the screening of irregular antibody,and the determination of antibody specificity and titer.A definite trial of HDN was used in 124 neonates who gave birth to pregnant women.The contents of the trial included serum bilirubin,free antibody test,antibody release test,red blood cell direct anti-human globulin test,neonatal ABO and Rh(D)typing.Results Among 420 pregnant women,413 cases had ABO blood group incompatibility,accounting for 98.33%of the total,10 cases of Rh(D)unqualified,3 cases of Rh(D)and ABO incompatibility at the same time.Among 413 cases of blood group incompatibility,170 cases(41.16%)had positive IgG anti-A(B)titer more than 64,and the positive rate of antibody in type O pregnant women was different from that of type A and B(P<0.05).Ten cases(2.42%)were positive for irregular antibodies.After the specific identification of the antibody,it is confirmed to be the IgG antibody of the Rh system,and the titer is 7~255.Thirty-four newborns(27.42%)were diagnosed as HDN,31 cases as ABO-HDN,3 cases were Rh-HDN.IgG anti-A(B)titer of pregnant women was compared,and there was significant difference among high,middle and low value groups(P<0.05).The Rh-HDN of 3 cases was caused by anti-D,anti-E and anti-C,respectively,accounting for 1/3 of the total.Conclusion Type O pregnant women are more likely to induce ABO-HDN than type A and B,and its incidence was increased according to the titer of IgG antibody in the mother.The irregular antibody in Rh system was more likely to cause Rh-HDN,which was closely related to bad pregnancy and the history of transfusion in pregnant women.