孕晚期孕妇血管内皮钙黏蛋白水平和IgG抗A/B抗体效价对ABO型胎儿新生儿溶血病的产前诊断价值

The value of vascular endothelial cadherin and IgG anti-A/B antibody titer in the prenatal diagnosis of ABO fetal hemolytic disease in pregnant women during the third trimester of pregnancy

目的研究孕晚期孕妇血管内皮钙黏蛋白(VE-Cad)水平和IgG抗A/B抗体效价对ABO型胎儿新生儿溶血病(HDFN)的产前诊断价值。方法选取2020年4月至2021年2月在青岛市黄岛区人民医院产检的O型Rh(D)阳性孕妇80例,且孕妇与丈夫血型不同,检测孕妇VE-Cad水平和IgG抗A/B抗体效价,随访孕妇至产后。依据新生儿发生ABO-HDFN情况将孕妇分为ABO-HDFN组(n=42)与对照组(n=38),分析两组孕妇VE-Cad水平和IgG抗A/B抗体效价,及其与患儿总胆红素的相关性,并根据受试者工作曲线(ROC)分析两者对产前诊断ABO-HDFN的价值。结果ABO-HDFN组孕妇的VE-Cad水平和IgG抗体效价高于对照组,差异有统计学意义VE-Cad(ng/mL)0.65(0.21~1.62)vs 2.25(1.15~5.12),P<0.0001;IgG抗体效价(≥1∶64)97.62%vs 44.74%,P<0.0001。ABO-HDFN组的孕母VE-Cad水平与新生儿总胆红素呈正相关(r=0.4264,P<0.05),但IgG抗体效价与新生儿总胆红素无显著相关性(r=0.0635,P=0.730)。VE-Cad水平的AUC为0.762,敏感度为80.95%,特异度为63.16%;IgG抗体效价的AUC为0.862,敏感度为88.10%,特异度为71.05%;两者联合诊断的AUC为0.915,敏感度为92.86%,特异度为84.21%。结论孕晚期孕妇的VE-Cad水平和IgG抗体效价联合检测对ABO-HDFN的产前诊断有重要参考价值。

Objective:To study the value of vascular endothelial cadherin(VE-Cad)level and IgG anti-A/B antibody titer in the prenatal diagnosis of ABO fetal hemolytic disease in pregnant women during the third trimester of pregnancy.Methods:From April 2020 to February 2021,80 pregnant women who were type O Rh(D)positive and had different blood types from their husbands were selected.Pregnant women were divided into ABO-HDFN group(n=42)and control group(n=38)according to the occurrence of ABO-HDFN in newborns.Then the levels of VE-Cad and IgG anti-A/B antibody titer of the two groups were compared and analyzed,and their correlation with total bilirubin in children,and their value for the prenatal diagnosis of ABO-HDFN was analyzed.Results:The VE-Cad level and IgG antibody titer of pregnant women in the ABO-HDFN group were higher than those of the control group,and the difference was statistically significant[VE-Cad(ng/mL):0.65(0.21~1.62)vs.2.25(1.15~5.12),P<0.0001;IgG antibody titer(≥1∶64):97.62%vs 44.74%,P<0.0001].There was a positive correlation between VE-Cad level and total bilirubin(r=0.4264,P<0.05)in the ABO-HDFN group,but no significant correlation between IgG antibody titer and TBIL(r=0.0635,P=0.730).The AUC of the VE-Cad level was 0.762,the sensitivity was 80.95%,and the specificity was 63.16%.The AUC,sensitivity and specificity of IgG antibody were 0.862,88.10%and 71.05%,respectively.The AUC,sensitivity and specificity of the combined diagnosis were 0.915,92.86%and 84.21%respectively.Conclusion:The combined detection of VE-Cad level and IgG antibody titer in pregnant women in the third trimester has important reference value for the prenatal diagnosis of ABO-HDFN.