网织红细胞计数在新生儿ABO溶血病IVIG治疗中的指导作用研究

Effect of Reticulocyte Count in IVIG Treatment of Neonatal ABO Hemolytic Disease

目的研究新生儿ABO溶血病患儿网织红细胞计数对静脉免疫球蛋白使用的指导意义。方法采用前瞻性分析方法,将2019年10月至2020年4月间收住于昆明医科大学第一附属医院儿科确诊为新生儿ABO溶血病且入院时网织红细胞百分比≤6%的70例新生儿纳入本次研究,随机分为非IVIG组和IVIG组。非IVIG组仅采取蓝光等对症支持治疗,IVIG组在光疗等治疗基础上加用静脉免疫球蛋白。比较IVIG组和非IVIG组两组患儿住院时间、经皮胆红素峰值、血红蛋白、网织红细胞百分比的不同及相关并发症的发生率。结果IVIG组住院时间为(5.8±1.9)d,经皮胆红素峰值为(14.4±2.3)mg/dL,峰值出现时间为日龄(4.6±1.5)d,血红蛋白下降幅度为(16.1±10.1)g/L,网织红细胞百分比下降幅度为(2.2±0.7)%,住院期间并未发生胆红素脑病等相关并发症;非IVIG组住院时间为(5.1±1.4)d,经皮胆红素峰值为(14.9±2.2)mg/dL,胆红素峰值出现时间为日龄(4.8±1.1)d,血红蛋白下降幅度为(15.3±12.4)g/L,网织红细胞百分比下降幅度为(2.4±0.8)%,住院期间未发生胆红素脑病等相关并发症。两组间无统计学差异。结论对于网织红细胞百分比≤6%的新生儿ABO溶血病患儿,使用IVIG可能并不能降低胆红素峰值及缩短住院时间。

Objective To study reticulocyte count for intravenous immunoglobulin use in newborns diagnosed with neonatal ABO hemolytic disease.Methods Using prospective analysis method,from October 2019 and April 2020,70 newborns with neonatal ABO hemolytic disease were included that reticulocyte percentage was less than or equal to 6%.They were divided into non-IVIG and IVIG group randomly.Non-IVIG group only received basic treatment such as phototherapy,while IVIG group were administered by intravenous immunoglobulin and phototherapy.Differences in hospitalization time,total bilirubin peak,hemoglobin,reticulocytes percentage and related complications were compared.Results In IVIG group,hospital stay was(5.8±1.9)days,peak percutaneous bilirubin was(14.4±2.3)mg/dL,peak time of bilirubin occurred was(4.6±1.5)days,and decrease in hemoglobin was(16.1±10.1)g/L,decrease in reticulocyte pencentage was(2.2±0.7)%.There were no related complications such as bilirubin encephalopathy during hospitalization.In non-IVIG group,hospital stay was(5.1±1.4)days,peak percutaneous bilirubin was(14.9±2.2)mg/dL,peak time of bilirubin occurred was(4.8±1.1)days,decrease in hemoglobin was(15.3±12.4)g/L and decrease in reticulocyte pencentage was(2.4±0.8)%.There were no related complications such as bilirubin encephalopathy during hospitalization.There was no statistical difference.Conclusion For neonatal ABO hemolytic disease with a reticulocyte percentage of less than or equal to 6%,IVIG might not reduce peak of bilirubin and shorten hospital stay.