Rh(D)初筛阴性孕妇Rh表型及抗D同种免疫人群的RHD基因分析

Analysis of Rh phenotype and RHD genotype of anti-D alloimmune population in Rh-negative pregnant women

目的:探讨Rh(D)初筛阴性孕妇的Rh表型分布及抗D同种免疫个体的Rh表型与RHD基因型特征,从而对Rh(D)阴性孕妇制定不同的检测和防治策略。方法:整理2010年5月至2022年5月检测的Rh(D)初筛阴性孕妇的Rh表型。收集Rh(D)确认阴性或D变异型且抗体筛查阳性的标本,鉴定为Rh血型系统同种抗体的标本应用PCR-SSP方法鉴定RHD基因型,同时采用血清学方法检测Rh表型。结果:2010年5月至2022年5月,去除重复检测孕妇,共计729例Rh(D)初筛阴性孕妇,其中ccee 435例(59.67%)、Ccee 202例(27.71%)、ccEe 48例(6.58%)、CcEe 21例(2.88%)、CCee 19例(2.61%)、CCEe 3例(0.41%)、ccEE 1例(0.14%)。共有30例产生Rh血型系统同种抗体的Rh(D)初筛阴性孕妇,抗D 29例,抗E 1例。Rh确认阴性产生抗D的个体共28例,Rh表型ccee 24例,ccEe 4例,基因型均为RHD全缺失型;产生抗E的个体1例,Rh表型为Ccee,基因型为DEL RhD1227A纯合子。D变异型产生抗D的个体1例,Rh表型为Ccee,基因型为DVIⅢ型。结论:徐州地区Rh(D)初筛阴性孕妇Rh表型以ccee为主。Rh表型为RhC-、基因型为RHD全缺失型及DVIⅢ型的个体易产生抗D同种免疫,产前意外抗体筛查应重点监测。

Objective: To investigate the phenotypic distribution of Rh-negative pregnant women and the Rh phenotype and RHD genotype characteristics of anti-D alloimmune individuals in this area, so as to formulate different detection and prevention strategies for Rh(D)-negative pregnant women. Methods: The Rh types of Rh-negative pregnant women in laboratory tests from May 2010 to May 2022 were sorted out. The Rh-negative or D variant antibodies screening positive were collected, and the specimens identified as Rh system alloantibodies were identified by PCR-SSP method to identify the RHD genotype. The Rh phenotype was detected by serological method. Results: From May 2010 to May 2022, a total of 729 pregnant women were excluded from repeated testing, including 435 ccee(59.67%), 202 Ccee(27.71%), 48 ccEe(6.58%), 21 CcEe(2.88%), 19 ccee(2.61%), 3 CCEe(0.41%) and 1 ccEE(0.14%). A total of 30 cases of Rh system alloantibodies were detected, including 29 cases of anti-D and 1 case of anti-E. A total of 28 cases of Rh-negative individuals with anti-D alloimmunization, 24 cases of Rh type ccee, 4 cases of ccEe, all of which were RHD full deletion genotype;1 case of anti-E, Rh type Ccee and genotype was DEL RhD1227A homozygote. One case of D variant with anti-D alloimmunization, Rh type Ccee, and genotype was DVIⅢ. Conclusion: The Rh phenotype of Rh(D)-negative pregnant women in Xuzhou area was mainly ccee. Individuals with RhC-negative, genotype RHD total deletion type and DVIⅢ type might be prone to anti-D alloimmunity, and prenatal accidental antibody screening should be monitored.