不同孕期ABO血型IgG抗体效价预测新生儿溶血病发生的效能比较

Titers of anti-A or anti-B IgG in predicting the occurrence of hemolytic disease of fetus or newborn

目的探讨孕妇孕中期IgG抗-A或抗-B抗体效价预测新生儿溶血病(HDFN)发生的效能。方法选取2018年1月至2019年11月在浙江省人民医院产检的孕妇165例,依据抗体效价检测孕周分为孕中期组76例和孕晚期组89例。分别比较两组IgG抗-A或抗-B抗体效价与新生儿HDFN发生、新生儿网织红细胞计数、TBil等实验室指标、高胆红素血症危险程度分级及治疗方式的相关性,ROC曲线分析两组抗体效价预测HDFN的效能,R语言bootstrap法分析预测效能的差异。结果两组抗体效价与HDFN发病、高胆红素血症危险程度分级均相关(均P<0.05),孕中期组IgG抗体效价还与新生儿网织红细胞计数及比率、丙种球蛋白治疗方式呈正相关(均P<0.05)。孕中期ABO血型IgG抗体效价预测HDFN的AUC为0.81(95%CI:0.71~0.91,P<0.01),最佳预测临界值为64,灵敏度为0.8636,特异度为0.5741;孕晚期以上指标分别为0.77(95%CI:0.64~0.91,P<0.01)、64、0.8125、0.5811,两组比较无统计学差异(均P>0.05)。结论孕妇孕中期ABO血型IgG抗-A或抗-B抗体效价预测HDFN发生的效能与孕晚期比较无差异。临床或可将孕期ABO血型IgG抗体效价检测提早至孕中期,为后续HDFN治疗争取更多时机。

Objective To investigate the value of the anti-A or anti-B IgG titers in predicting the occurrence and severity of hemolytic disease of fetus or newborn(HDFN).Methods One hundred and sixty-five pregnant women under-going antepartum examination for ABO HDFN from January 2018 to November 2019 were enrolled,including 76 cases having examination in the second trimester of pregnancy and 89 cases in the third trimester of pregnancy.The correlation of maternity anti-A or anti-B IgG titers with the occurrence of(HDFN),hemolysis laboratory indexes,high bilirubin risk classification and treatment methods was analyzed.ROC curve was used to analyze the prediction efficacy,R language bootstrap method was used to analyze the difference of prediction effectiveness.Results The anti-A or anti-B IgG titers of the two groups were correlated with the incidence of hemolytic disease and the risk grade of hyperbilirubin(P<0.05).The anti-A or anti-B IgG titers of the second trimester were also positively correlated with reticulocyte count,reticulocyte ratio and treatment with intravenous administration of immunoglobulin(P<0.05).The area under ROC curve(AUC)for neonatal hemolysis was 0.81(95%CI:0.71-0.91,P<0.01)in the second trimester,the best predictive cutoff value was 64,the sensitivity was 0.8636,and the specificity was 0.5741.The above indexes in the third trimester were 0.77(95%CI:0.64-0.91,P<0.01),64,0.8125,0.5811,respectively.There was no statistical difference between the two groups(P>0.05).Conclusion The anti-A or anti-B IgG titers can predict the occurrence and severity of hemolytic disease of fetus or newborns,both in second and third trimester of pregnancy;however,examination in the second trimester can have more time for follow-up treatment.