ABO血型不合新生儿溶血病与血液检测指标关系及其诊断价值

Correlation between blood detective indicators of neonates with hemolytic disease due to ABO blood group incompatibility and the diagnostic value

目的:探索ABO血型不合新生儿溶血病(HDN)与血液检查指标关系以及HDN血型分布。方法:回顾性分析2016年4月-2021年4月本院分娩的2565例孕妇临床资料,抽取新生儿脐带血和夫妻双方抗凝血检测,统计HDN患病率并分析与孕妇体内IgG抗A(B)抗体效价相关性,根据HDN分为溶血组(n=109)和非溶血组(n=2456),比较HDN患病情况与血液指标相关性,采用受术者工作特征曲线(ROC)曲线分析各血液指标预测HDN效能。结果:发生HDN 109例,4.2%;血型主要以O-A-A型为主,其次为O-AB-A型,孕妇血清IgG抗A(B)抗价效价越高,HDN发生率越高。经Spearman法分析,HDN患病情况与血红蛋白含量呈负相关性,与中性粒细胞、平均红细胞血红蛋白浓度、总胆红素呈正相关性;经ROC曲线分析,总胆红素、平均红细胞血红蛋白浓度、中性粒细胞、血红蛋白及4项联合早期预测HDN的曲线下面积=0.954、0.865、0.925、0.738、0.991,有一定临床指导价值。结论:ABO血型不合的HDN血型主要以O-A-A型为主,血液检查预测HDN患病有一定临床意义,提示临床早期检测,及时诊断治疗。

Objective: To explore the correlation between hemolytic disease of neonate(HDN) of ABO blood type incompatibility and their blood detective indicators, and to study the blood types distribution of HDN. Methods: The clinical data of 2,565 pregnant women who gave birth between April 2016 and April 2021 were analyzed retrospectively. The neonatal cord blood and the blood of their parents were collected for anticoagulant blood testing. The prevalence of HDN was calculated. The correlation between the prevalence of HDN and the IgG anti-A(B) antibody titer of the pregnant women was analyzed. The neonates were divided in group A(109 cases with HDN) and group B(2456 without HDN). The prevalence of HDN was compared between the two groups. The correlation between HDN and the blood indicators of the neonate was analyzed. Receiver operator characteristic(ROC) curve was used to analyze the efficacy of the blood indicators for predicting HDN. Results: There were 109(4.2%) neonates with HDN. The main blood type of the neonates with HDN was O-A-A, and followed by O-AB-A blood type. The higher serum IgG anti-A(B) titer of the women was, the higher the incidence of their HDN. Spearman analysis showed that the rate of HDN of the neonate was negatively correlated with their hemoglobin content and was positively correlated with the values of their neutrophil and, mean RBC hemoglobin concentration, and total bilirubin. ROC curve analysis showed that the area under the curve of the total bilirubin value, the mean RBC hemoglobin concentration, the neutrophil value, the hemoglobin value, and the combination of the total bilirubin value, the mean RBC hemoglobin concentration, the neutrophil value, and the hemoglobin value of the neonate for early predicting HDN were 0.954, 0.865, 0.925, 0.738, and 0.991, respectively, which all had certain clinical guiding values for diagnosis and treatment of HDN. Conclusion:HDN of the neonate with ABO blood group incompatibility are mainly O-A-A ty pe.The blood detective indicators for predicting HDN has certain clinical significance,which suggests that early detection of thes blood indicators and timely diagnosis and treatment of HDN should be conduct in clinic.