新生儿溶血病检查在重度高胆红素血症患儿诊疗中的意义

Significance of HDN detection for newborn with severe hyperbilirubinemia

目的:探讨新生儿溶血病(HDN)在重度高胆红素血症患儿诊断治疗中的临床意义。方法:对300例重度高胆红素血症患儿进行HDN血型血清学检查,回顾性分析HDN结果与血清总胆红素(TSB)、日龄之间的关系。结果:300例重度高胆红素血症新生儿标本中,共检出ABO-HDN 134例(44.67%)、ABO以外HDN 20例(6.67%)、未检出HDN 146例(48.67%),3组日龄差异有统计学意义(P<0.01),TSB差异无统计学意义(P>0.05);母婴血型O/A型与O/B型其HDN检出率差异无统计学意义(P>0.05);重度、极重度、危险性高胆红素血症HDN检出率差异无统计学意义(P>0.05),TSB及日龄差异均有统计学意义(均P<0.01);HDN检出率随日龄增长呈下降趋势,其中日龄1～5 d呈快速下降趋势,5～9 d呈平稳趋势,9 d以上呈缓慢下降趋势,TSB随日龄增长呈先上升后下降趋势,于9.5 d龄处达到峰值,约为516μmol/L。结论:HDN结果与新生儿日龄密切相关,对重度高胆红素血症患儿病因的早期识别与诊断有较大临床意义,临床标本应尽快送检,以免错过最佳检测时机。

Objective:To discuss the clinical significance of hemolytic disease of newborn(HDN)in the diagnosis of newborn with severe hyperbilirubinemia.Method:HDN detection were conducted for 300 cases of newborn with severe hyperbilirubinemia,and retrospective analysis on the relationship between HDN results and total serum bilirubin(TSB),as well as age,was made.Result:In the specimens of 300 newborn with severe hyperbilirubinemia,20 were N-ABO-related HDN(6.67%),134 were ABO-related HDN(44.67%),and 146 were free from HDN(48.67%).Among the three groups,the difference of age was significant(P<0.01),while their TSB were nearly the same(P>0.05).There was no significant difference on the detection rates of HDN between cases of maternal/infant blood group O/A and O/B(P>0.05).The difference of HDN detection rates between cases with severe(n=103),extremely severe(n=116)and dangerous(n=81)hyperbilirubinemia was not statistically significant(P>0.05),but the differences of TSB and age between these three groups were statistically significant(P<0.01).The detection rate of HDN decreased with age,showed as a trend line with a rapid decline phase in 1-5 days,a steady phase in 5-9 days,and a slow decline phase 9 days later.Besides,TSB increased first and then decreased with age,reaching the peak level on day 9.5,the value was about 516μmol/L.Conclusion:HDN detection has a great clinical significance for the early identification and diagnosis of the cause of newborn with severe hyperbilirubinemia,we are convinced that there is a correlation between HDN detection results and the corresponding age of newborn.Clinical specimens should be detected as soon as possible,lest they miss the best time to receive inspections.