O型孕产妇IgG抗体效价与胎儿新生儿溶血病关系的Meta分析

Meta analysis of the relationship between the antibody titer of serum anti-A(B) blood type of IgG in pregnant women with O blood type and hemolytic disease of fetus and newborn in China

目的通过Meta分析综合评价孕妇血清ABO IgG抗体效价与胎儿新生儿溶血病(ABO-HDFN)之间的关系。方法计算机检索中国生物医学数据库和中国学术期刊全文数据库、中文科技期刊数据库、万方数据资源系统及维普中关于中国孕妇血清IgG抗体效价与胎儿新生儿溶血病相关文献,检索时限为2010年1月—2019年12月。有5位参与研究人员按照纳入和排除标准独立筛选目标文献、质量评价和资料提取,采用Stada15.0和R3.5.2做Meta分析。结果从184篇文献中最终筛选出合格的文献16篇纳入Meta分析,结果表明当母体血清中IgG抗-A(B)效价超过64或128时,其因血型不合发生胎儿新生儿溶血病的危险性RR分别为8.97(95%CI,6.04—13.32)和8.73(95%CI,6.47—11.78)。对检测方法进行分层分析发现,以孕妇体内IgG抗-A(B)效价不超过64为对照,微柱凝胶法和试管法抗球蛋白检测2种检测方法对结果并无明显影响;以孕妇体内IgG抗-A(B)效价不超过128为对照时,微柱凝胶法所对应的相对危险度显著高于试管法。发表偏倚检测:纳入的文献发表偏倚不明显,分析结果可信度较高。结论 ABO-HDFN发病的相对危险度与O型血母亲IgG抗-A(B)效价相关,监测孕妇血清IgG抗-A(B)效价有助于早期发现ABO-HDFN,尤其是当孕妇血清IgG抗-A(B)效价超过64时,可予以产前干预降低抗体效价。定期监测O型孕妇IgG抗-A(B)效价对指导ABO-HDFN防治具有重要意义。

Objective To evaluate the relationship between the antibody titer of antepartum serum anti-A(B) blood type of IgG in pregnant women with O blood type and fetal hemolytic disease of newborn(ABO-HDFN) by Meta-analysis. Methods Literature regarding the level of antibody titer of antepartum serum anti-A(B) blood type of IgG in Chinese pregnant women with O blood type and ABO-HDFN were searched in Chinese Biomedical Database, Chinese Academic Journal Full-text Database, Chinese Science and Technology Journal Database, Wanfang Data Resource and Chongqing VIP, covering a period of 10 years spanned between January 2010 and December 2019. According to the inclusion and exclusion criteria, 5 researchers independently screened the target literature, evaluated the quality, extracted the data, and used Stada15.0 and R3.5.2 for Meta analysis.Results 16 out of 184 publications were finally included into Meta analysis. The results revealed that when the serum IgG antibody titer in maternal serum exceeded 64 or 128, the relative risk(RR) of ABO-HDFN was 8.97(95% CI,6.04—13.32)and 8.73(95% CI,6.47—11.78), respectively. When stratifying by testing methods, no significant differences in testing results were notable by microcolumn gel method or tube method using serum IgG anti-A(B) antibody titer ≤ 64 as the control;RR of microcolumn gel method was significantly higher than tube method using serum IgG anti-A(B) antibody titer ≤ 128 as the control. The publication bias of the included literature was not obvious, and the reliability of results was high. Conclusion The RR of ABO-HDFN is related to the IgG anti-A(B) titer of mothers with O blood type. Monitoring the IgG anti-A(B) titer of pregnant women is helpful for early diagnosis of ABO-HDFN, especially when the IgG anti-A(B) titer of pregnant women exceeds 64, preventive treatment can be carried out to reduce the antibody titer. Dynamic monitoring of antepartum IgG anti-A(B) titer of pregnant women with O blood type is of great significance to guide the prevention and treatment of ABO-HDFN.