新生儿溶血3项试验与血型抗体IgG亚型的相关性分析

Correlation Analysis between the Three Hemolytic Tests and the Blood Type Antibody IgG Subtypes

目的探讨新生儿溶血3项试验与血型抗体IgG亚型的相关性,评价IgG抗体亚型检测的临床价值,为临床后续治疗提供理论依据。方法对2018年7月~2019年7月在笔者医院分娩的65例产前血型抗体高效价的孕产妇进行产后新生儿血型血清学检测(ABO 58例,Rh 7例),采用微柱凝胶技术分别检测新生儿血型、溶血病3项试验和血型抗体IgG亚型含量。结果65例新生儿中有42例溶血试验证实为与血型有关的新生儿溶血病。31例患儿血清中检测到IgGl亚型含量升高,27例IgG2升高,10例IgG3升高,IgGl和IgG3亚型升高的新生儿均出现重症高胆红素血症,而5例仅IgG4亚型升高的新生儿均未出现溶血相关的高胆红素血症,提示新生儿IgGl和IgG3抗体亚型的含量与高胆红素血症的危重程度密切相关。溶血3项试验对诊断新生儿溶血病具有一定的参考价值,但对判定新生儿溶血病的严重程度,其结果的准确性不高,临床上不能以此作为评估患儿黄疸严重程度和干预治疗的指标。结论新生儿溶血3项试验与血型抗体IgG亚型含量具有一定的相关性,溶血病严重程度与血型抗体IgGl和IgG3亚型含量呈正相关、对溶血3项试验阳性的新生儿有必要进行IgG抗体亚型分析,从而实现个体化精准治疗。

Objective To explore the correlation between the three tests of neonatal hemolysis and the blood group antibody IgG subtypes,in order to evaluate the clinical value of IgG antibody subtypes detection and to provide a theoretical basis for subsequent treatment.Methods The postpartum neonatal blood group serology test was performed on 65 pregnant women with high titers of prenatal blood group antibodies delivered in our hospital from July 2018 to July 2019(58 cases of ABO and 7 cases of Rh).The microcolum gel technology assay were used to detect neonatal bloodtype,hemolytic disease three tests and blood group antibody IgG subtype content.Results Totally 42 of 65 newborns were confirmed to have blood group-related neonatal hemolytic disease by hemolysis tests.The serum levels of IgGl subtypes increased in 31 cases,IgG2 subtypes increased in 27 cases,and IgG3 increased in 10 cases and IgGl and IgG3 subtypes increased in neonates with severe hyperbilirubinemia.None of the neonates with elevated IgG4 subtype were found to have hyperbilirubinemia.The content of IgGl and IgG3 antibody subtypes was closely related to the severity of hyperbilirubinemia.The three hemolytic tests have certain diagnostic value for neonatal hemolytic disease.However,the accuracy of determining the severity is not high,and it cannot be used as an index to evaluate the severity of jaundice in the newborns and intervention treatment.Conclusion The three tests of neonatal hemolysis have a certain correlation with the content of IgG subtypes of blood group antibodies.The severity of hemolytic disease was positively correlated with the content of IgGl and IgG3 subtypes of antibodies.It was necessary to analyze IgG subtypes for newborns with positive hemolysis tests.In order to carry out an individuation precise intervention treatment.