Rh阴性孕妇IgG抗体亚型与新生儿溶血病的相关性研究

Study on relationship between IgG antibody subtypes of Rh negative pregnant women and hemolytic disease of newborn

目的:探讨产前稀有血型孕妇IgG抗体亚型与新生儿溶血病(hemolytic disease of the newborn,HDN)的相关性。方法:选择2020年5月至2022年5月接收的Rh(D)阴性孕妇81例,对所有孕妇临床资料进行回顾性分析。检测夫妇血型、孕妇不规则抗体、孕妇IgG抗体效价及其亚型含量、新生儿溶血相关试验,对产前稀有血型孕妇IgG抗体各亚型及新生儿溶血情况进行分析,并分析产前稀有血型孕妇IgG抗体亚型与HDN的相关性。结果:81例孕妇中Rh-HDN总发生率为56.79%,母亲血清IgG1、IgG2、IgG3、IgG4亚型抗体检测含量高于非HDN组(P<0.05)。轻度黄疸组IgG1、IgG3亚型含量与中重度黄疸组比较,差异有统计学意义(P<0.05)。经多因素分析,IgG1是影响HDN发生的独立危险因素(P<0.05)。轻度黄疸组IgG1、IgG3亚型含量与中重度黄疸组比较,差异有统计学意义(P<0.05)。81例孕妇血清抗D抗体效价≥64者58例,产后新生儿20例发生重度HDN,进行换血治疗,换血率达34.48%。结论:稀有血型孕妇产前需检测血型抗体IgG亚型,对高效价孕妇需行IgG亚型分析,若IgG1、IgG22种亚型明显上升则应及时给予积极干预治疗,以实现早期精准诊断及治疗。

Objective To investigate the correlation between IgG antibody subtypes of prenatal pregnant women with rare blood types and hemolytic disease of the newborn(HDN).Methods A total of 81 Rh(D)negative pregnant women admitted to our hospital from May 2020 to May 2022 were selected,and the clinical data of all pregnant women were retrospectively analyzed.The blood type of the couple,the irregular antibody of pregnant women,the titer and subtype content of IgG antibody in pregnant women and the related test of neonatal hemolysis were detected.Correlation between blood group IgG antibody subtypes in pregnant women and hemolytic disease of the newborn was analyzed.Results The total incidence of Rh-HDN in 81 pregnant women was 56.79%.The maternal serum IgG1,IgG2,IgG3 and IgG4 subtype antibody levels in Rh-HDN group were higher than those in non-HDN group(P<0.05).The contents of IgG1 and IgG3 subtypes in the mild jaundice group were compared with those in the moderate and severe jaundice group(P<0.05).After multivariate analysis,IgG1 was an independent risk factor for the occurrence of HDN(P<0.05).The content of IgG1 and IgG3 subtypes in the mild jaundice group was significantly different from that in the moderate and severe jaundice group(P<0.05).Of the 81 pregnant women,58 had serum anti-D antibody titers≥64,and 20 postpartum neonates developed severe HDN.Exchange transfusion was performed,and the exchange transfusion rate was 34.48%.Conclusion Pregnant women with rare blood types need to detect IgG subtype of blood group antibodies before delivery,and IgG subtype analysis is required for pregnant women with high titer.If the two subtypes of IgG1 and IgG2 are significantly increased,active intervention should be given in time to achieve early accurate diagnosis and treatment.