非ABO新生儿溶血病的调查分析

Investigation and Analysis of Non-ABO Hemolytic Disease of the Newborn

目的:通过回顾性病例分析,研究不规则抗体引起的新生儿溶血病(HDN)的血清学检测特点和抗体特异性分布。方法:选取2014年1月至2019年12月本院新生儿科送检的疑似HDN病例3 047例,以本实验室检测证实为非ABO-HDN的病例为研究对象,同期检测标本中随机选取的ABO-HDN病例作为对照,分析致病抗体特异性、血清学检测特点、总胆红素变化趋势以及患儿性别构成比。结果:送检病例中67例确诊为非ABO-HDN患儿,其中男性患儿45例,阳性率1.48%;女性患儿22例,阳性率0.72%。65例患儿母亲有≥2次的妊娠史。检出的不规则抗体主要涉及Rh系统、MNS系统、Kidd系统和Lewis系统,其中Rh系统最多,抗体检出率88.07%。与ABO-HDN患儿相比,非ABO-HDN患儿的总胆红素水平发展较迅速,峰值较高(P<0.001),且持续时间较长。在血清学检测方面,非ABO-HDN直抗试验阳性率97.01%,高于ABO-HDN直抗试验阳性率47.00%(P<0.001),且凝集强度常常≥2+,但仍存在直抗弱阳性或阴性的情况。结论:不规则抗体导致的非ABO-HDN大多发生在母亲有多次妊娠史的胎儿,且男性患儿多于女性患儿,检出的不规则抗体以Rh系统为主。与ABO-HDN患儿相比,非ABO-HDN患儿的胆红素峰值较高且持续时间长。直抗试验结果或能用于粗略区分ABO-HDN和非ABO-HDN。

Objective: To study the serological detection characteristics and antibody specific distribution of hemolytic disease of the newborn(HDN) caused by irregular antibodies through retrospective case analysis. Methods: A total of3 047 suspected cases of HDN were submitted by the Neonatal Department of our hospital from January 2014 to December2019. Non ABO-HDN cases confirmed in our laboratory were taken as the research objects, while some cases of ABOHDN were randomly selected as control. Disease-causing antibody specificity, serological detection characteristics, total bilirubin change trend and gender ratio of non ABO-HDN patients were explored. Results: Sixty-seven cases of non ABO-HDN were confirmed from the suspected cases of HDN, Among which 45 males and 22 females were detected with the positive rate 1.48% and 0.72%, respectively. The mothers of 65 cases had two or more pregnancies. The detected irregular antibodies were mainly involved with Rh system, MNS system, Kidd system and Lewis system, among which Rh system accounted for 88.07% of the total antibody detection rate. Compared with that of ABO-HDN patients, the total bilirubin of non ABO-HDN patients developed more rapidly with a higher peak and a longer duration(P<0.001). In terms of serological detection, the positive rate of non ABO-HDN direct antibody test was 97.01%, which was higher than 47.00% of ABO-HDN(P<0.001), and the agglutination strength was often ≥ 2+, but there were still weak positive or negative cases of direct antibody test. Conclusion: Non ABO-HDN caused by irregular antibodies mostly occurs in fetuses whose mothers experience multiple pregnancies, and the number of males is more than females. The irregular antibodies detected are mainly attributed to Rh system. The peak value of bilirubin in non ABO-HDN patients is higher and lasts longer than that in ABO-HDN patients. Direct antiglobulin test may be used to roughly distinguish ABO-HDN from non ABO-HDN.