母儿ABO血型不合的治疗及母体血清抗体与新生儿黄疸的关系

The treatment and the relation between maternal serum antibody and jaundice degree of the newborn of maternal-fetal ABO blood group incompatibility

目的 探讨母儿ABO血型不合的孕期治疗以及分娩前母体血清抗体效价与新生儿黄疸程度的关系。方法 回顾性分析 6 2例母儿ABO血型不合患者的孕期治疗资料。 6 2例患者采用中西医结合治疗 ,分为口服茵枝黄、静脉注射茵枝黄、静脉注射茵枝黄 +免疫治疗组。测定治疗前后血清抗体效价下降以及新生儿血清胆红素值 ,采用SPSS10 .0的Mann -Whitney检验 ,对 3组治疗前后的抗体效价变化值进行两两比较的统计分析 ,采用SPSS10 .0的直线回归 (linearregression)对分娩前母体血清抗体效价与新生儿血清胆红素值进行相关分析。结果 免疫治疗组分别与口服组 (P值 :抗A 0 .0 10 ,抗B0 .0 2 4 )、静脉组 (P值 :抗A 0 .0 2 7,抗B 0 .0 11)相比 ,治疗前后抗体效价下降具有显著性差异 ;分娩前母体血清抗体效价与新生儿血清胆红素值无显著相关关系 ,[TBILr=0 .0 82 ,P =0 .812 ;DBTLr=0 .30 0 ,P =0 .370 ]。结论 母儿ABO血型不合患者 ,一旦发生溶血 ,其严重程度并不像其发病率一般与分娩前母体血清抗体效价显著相关。为降低发病率 ,宜在孕期积极治疗 ,可采用中西医结合治疗 ,必要时加用免疫治疗。

Objective: To study the treatment during pregnancy and the relation between maternal serum antibody titer and jaundice degree of the newborn of maternal-fetal ABO blood group incompatibility. Method: We retrospectively analysed the obstetrical data of 62 maternal-fetal ABO blood group incompatibility. We used the combination of Chinese traditional and western medicine to treat them in pregnancy. The 62 cases were devided into 3 groups: the group by oral, the group by vein, the immunotherapy group. The materrnal serum antibody titer before and after the treatment were determined, then were statistical analysed in twos of the three groups with the Mann-whitney test. The serum TBIL and DBIL of the newborns of HDN were determined, then we used the linear regression to analyse the relation between the maternal serum antibody titer and the jaundice degree of the newborn. Results: 1) Significant decrease of maternal serum antibody titer were found in the immunotherapy group. [P: Ab-A 0.010, Ab-B 0.024, by oral] [P: Ab-A 0.027, Ab-B 0.011 by vein]. 2) The jaundice degree of the newborn do not increase when the maternal serum antibody titer increase [TBIL r=0.082, P=0.812; DBTL r=0.300, P=0.370]. Conclusion: When maternal serum antibody titer≥128 during later pregnancy, the degree do not increase as the morbidity of HDN (haemolytic disease of the newborn) when the maternal serum antibody titer increase. The combination of Chinese traditional and western medicine can be apply in pregnancy, we can add immunotherapy when antibody titer is too high.