溶血三项试验及碳氧血红蛋白在胎儿新生儿溶血病诊断中的价值

Value of three hemolysis tests and carboxyhemoglobin in the diagnosis of hemolytic disease of the fetus and newborn

目的 探讨溶血三项试验及碳氧血红蛋白(COHb)在胎儿新生儿溶血病(hemolytic disease of the fetus and newborn, HDFN)诊断中的价值。方法 选取2019年1月1日—2022年12月31日于本院新生儿科住院、疑似溶血病并送血清学检查的患儿,其中临床诊断为HDFN的患儿作为溶血组,排除HDFN的患儿作为对照组,对患儿临床及实验室资料进行回顾性收集及分析。COHb水平通过血气分析仪检测获得。结果 溶血组共纳入378例,对照组纳入217例,其中溶血组以足月儿为主(348/378, 92.1%),胎龄39.1(38.3, 40.0)周,354例(354/378,93.7%)为ABO-HDFN,其余为Rh-HDFN;溶血组与对照组间在入院时血清总胆红素、血红蛋白水平、COHb、网织红细胞百分比方面差异有统计学意义(P<0.05)。溶血组溶血三项试验阳性率随日龄增大而降低,2 d内阳性检出率高达80%以上,日龄与COHb之间存在负相关(rs=-0.434,P<0.001)。溶血组释放试验(69.0%)阳性率高于游离试验(55.6%)和直接抗人球蛋白试验(DAT)(36.0%)。建立受试者工作(ROC)曲线,取COHb≥1.15%为最佳截断值,灵敏度51.8%,与溶血三项试验联合并不能显著增加后者对HDFN的诊断效能(Z=-0.727,P>0.05),但其灵敏度高于单项DAT(36.0%)。结论 溶血三项试验对HDFN的诊断有重要价值,释放试验灵敏度最高。COHb对HDFN有一定诊断价值,但联合检测并不能显著增加溶血三项诊断效能。对于存在溶血风险的患儿,生后应尽早送检溶血试验及/或COHb检测。

Objective To investigate the value of three hemolysis tests and carboxyhemoglobin(COHb)level in the di⁃agnosis of hemolytic disease of the fetus and newborn(HDFN).Methods From January 1,2019 to December 31,2022,the neonates hospitalized in the Department of Neonatology of Hebei Provincial Children’s Hospital with suspected hemolytic disease who had serological testing were retrospectively enrolled in the study.They were distributed into HDFN group and non⁃HDFN group according to the final diagnosis.Their clinical and laboratory data were collected and analyzed,and the CO⁃Hb level was detected by blood gas analyzer.Results A total of 378 neonates with HDFN and 217 neonates without HDFN were included in the study.Most of the neonates in HDFN group were full⁃term infants(348/378,92.1%),with median gestational age of 39.1(38.3,40.0)weeks.Three hundred and fifty⁃four cases(354/378,93.7%)were ABO⁃HDFN and the rest were Rh HDFN.There were significant differences in the level of serum total bilirubin,hemoglobin,COHb and retic⁃ulocyte percentage at admission between the two groups(P<0.05).The positive rate of three hemolysis tests in HDFN group decreased with the increase of the days after birth.The highest positive rate(more than 80%)was observed within 2 days af⁃ter birth.Correlation analysis showed a negative relationship between the COHb level and the age(rs=-0.434,P<0.001).Among the three hemolysis tests in HDFN group,the positive rate of antibody release test was the highest(69.0%),followed by the free antibody test(55.6%)and the direct antiglobulin test(DAT)(36.0%).Receiver operating characteristic(ROC)curve analysis showed that the optimal cut⁃off value of COHb was 1.15%.The sensitivity of COHb≥1.15%was 51.8%,higher than single DAT(36.0%).The diagnosis effectiveness of three hemolysis tests couldn’t be improved when combined with COHb detection(Z=-0.727,P>0.05).Conclusion The three hemolysis tests are important in the diagnosis of HDFN,among which the antibody release test has the highest sensitivity.COHb has certain value for the diagnosis of HD⁃FN,but joint testing cannot improve the diagnosis effectiveness of three hemolysis tests.Hemolysis tests and/or COHb detection should be conducted for neonates at risk of hemolysis as early as possible after birth.hemolysis tests;carboxyhemoglobin(COHb)