RhD阴性孕妇IgG抗体效价的检测及换血疗法临床效果探讨

Detection of IgG antibody titer in RhD-negative pregnant women and clinical effect of exchange transfusion therapy

目的探讨RhD阴性孕妇产前免疫球蛋白(Ig)G抗体效价监测对新生儿溶血病(HDN)的诊断意义、Rh-HDN血清学试验及临床换血疗法治疗情况。方法回顾性分析2018年1月至2020年8月该院产科门诊收治的209例RhD阴性孕妇IgG抗体及同期在该院分娩的新生儿血清学试验检测结果及患儿临床资料。结果209例孕妇中IgG-抗A(B)效价>64的有80例,IgG-抗D阳性49例;临床确诊ABO-HDN 39例,全部为O型孕妇,确诊Rh-HDN 7例,O型孕妇1例、A型4例、B型2例;Rh-HDN特异性抗体鉴定结果为抗D 6例,抗D/抗C 1例;Rh-HDN溶血三项试验全部为强阳性;7例Rh-HDN有4例进行了换血治疗,黄疸及贫血症状得到明显改善。结论孕妇产前IgG抗体效价监测和血清学试验对于预防和及时治疗HDN具有重要意义,采用输液泵外周静脉自动换血术治疗高胆红素血症,防止核黄疸发生的效果显著。

Objective To investigate the diagnostic significance of prenatal immunoglobulin(Ig)G antibody titer monitoring in RhD-negative pregnant women for hemolytic disease of the newborn(HDN),Rh-HDN serological test and clinical treatment of exchange transfusion therapy.Methods From January 2018 to August 2020,209 cases of RhD-negative pregnant women with IgG antibodies in the hospital of obstetric outpatient clinic,as well as the serological test results and clinical data of neonates delivered in the hospital during the same period were retrospectively analyzed.Results Among the 209 pregnant women,80 had IgG anti-A(B)titers>64,and 49 had IgG anti-D positive.A total of 39 were clinically diagnosed with ABO-HDN,all of them were type O pregnant women,and 7 were diagnosed with Rh-HDN,with 1 case of type O pregnant woman,4 cases of type A,2 cases of type B.The identification results of Rh-HDN specific antibodies were anti-D in 6 cases and anti-D/anti-C in 1 case.All three Rh-HDN hemolysis tests were strongly positive.Of the 7 cases of Rh-HDN patients,4 cases underwent exchange transfusion therapy,and the symptoms of jaundice and anemia were significantly improved.Conclusion Prenatal IgG antibody titer monitoring and serological tests are of great significance for the prevention and timely treatment of HDN.The use of infusion pump peripheral venous exchange transfusion has a significant effect in the treatment of hyperbilirubinemia.