血清学诊断ABO新生儿溶血病的实验研究

The study of ABO Hemolytic Disease of the Newborn in serological diagnosis test ABSTRACT

目的：了解长沙地区 ABO 血型新生儿溶血病（HDN）的发病情况，探讨血清学三项实验在诊断新生儿溶血病中的临床价值，为该病的早期预防、早期诊断和临床治疗提供依据。方法：收集中南大学湘雅医院2016年1月~7月产科和新生儿科疑似母婴 ABO 血型不合的新生儿血液标本，对其进行 ABO 血型检测及新生儿溶血病血清学三项试验（直接抗人球蛋白试验、游离抗体试验和红细胞抗体释放试验）。结果：在583例检测结果中，确诊为新生儿溶血病的有145例，发病率为24.87%。其中男性患儿80例，发病率为25.64%，女性患儿65例，发病率为23.98%，差异无统计学意义；A 型血患儿90例，O-A 型母婴血型模式的发病率为54.88%，B 型血患儿55例，O-B型母婴模式的发病率为41.35%，差异显著。145例 HDN 中直接抗人球蛋白试验阳性38例，阳性率26.21%，游离抗体试验阳性76例，占52.41%，红细胞抗体释放试验阳性144例，阳性率为99.31%，三者比较存在着显著的差异性。结论：长沙地区 ABO 新生儿溶血病发病率为24.87%，男性新生儿和女性新生儿的发病率无差异性，O-A 母婴血型发病率高于 O-B 母婴血型。血清学三项试验是临床最常用的诊断新生儿溶血病的方法，其中红细胞抗体释放试验敏感度最高，游离抗体试验次之，直接抗人球蛋白试验敏感度最低。血清学诊断为 ABO 新生儿溶血病的早期预防、早期诊断和临床治疗提供依据。

Obejective To understand the morbidity of ABO hemolytic disease of the newborn in Changsha, discuss the clinical significance of three serologic tests to diagnose the ABO hemolytic disease of the newborn and provide evidences for the early prevention, early diagnosis and clinical treatment of the disease. Methods Collecting the total of 583 cases of maternofe-tal ABO incompatibility from January 2016 to July in Xiangya Hospital of Central South University. The ABO blood group and serologic tests were determined. Results There are 145 cases of HDN in the total of 583 blood samples with the incidence 24.87%. The number of male children was 80 (25.64%) and female children was 65(23.98%). There was no significance differ-ence in their incidences. In 145 cses of ABO-HDN with positive result in 90 cases with O-A incompatible pregnancies (54.88%), 55 cases with O-B incompatible pregnancies (41.35%), as a result, there were differences between these two blood group and the incidence of type A was higher than type B. In 145 cases of ABO-HDN, the direct antiglobulin test (DAT) with positive result was 38(26.21%), free antibody test was 76 (52.41%) and the RBC antibody release test was 144(99.31%). There were differences among the three serological tests. Conclusion The morbidity of ABO-HDN in changsha is about 24.87%. No dif-ference was found between the male children and female children. The three serological hemolytic tests are the most important methods for diagnosis of ABO-HDN, in which the most sensitive is RBC antibody release test, followed by free antibody test and DAT. The three serologic tests are helpful in the early prevention, early diagnosis and clinical treatment of the disease.