目的 通过对RhD阴性孕产妇腹中胎儿和分娩的新生儿发生胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)的相关指标对比分析,为预防和治疗HDFN提供参考和指导。方法 收集我院2018年1月—2022年12月分娩的RhD阴性孕产...目的 通过对RhD阴性孕产妇腹中胎儿和分娩的新生儿发生胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)的相关指标对比分析,为预防和治疗HDFN提供参考和指导。方法 收集我院2018年1月—2022年12月分娩的RhD阴性孕产妇737名,比较新生儿是否发生RhD血型不合、ABO血型不合导致的HDFN及其影响因素,发生RhD-HDFN和发生ABO-HDFN的相关影响因素。分析发生RhD-HDFN和发生ABO-HDFN患儿的实验室指标差异;分析IgG抗-D效价≤16和≥32的孕产妇分娩的新生儿发生RhD-HDFN的实验室指标差异。结果 737名RhD阴性孕产妇中,发生RhD-HDFN的母婴ABO血型相同或相容者比率88.89%(40/45)显著高于母婴ABO血型不相容者11.11%(5/45)。母体二次妊娠及以上发生RhD-HDFN比率93.33%(42/45)显著高于ABO-HDFN 60.66%(37/61)者。母体IgG抗-D效价≥32者分娩的新生儿血红蛋白(hemoglobin,Hb)最低值低于母体IgG抗-D效价≤16者(χ^(2)=5.61,P<0.05),母体IgG抗-D效价≥32者分娩的新生儿血清总胆红素(total bilirubin,TBil)峰值高于IgG抗-D效价≤16者(χ^(2)=4.471,P<0.05)。结论 RhD阴性孕产妇中,母婴ABO血型相同或相容及孕产次≥2者,相应新生儿更易发生RhD-HDFN,母体IgG抗-D效价≥32者发生新生儿溶血的严重程度显著高于抗-D效价≤16者。展开更多
Background: The D antigen is the most important and immunogenic antigen of the Rh blood group;its correct screening prevents any risk of alloimmunization in the RHD negative recipient. The D negative phenotype is char...Background: The D antigen is the most important and immunogenic antigen of the Rh blood group;its correct screening prevents any risk of alloimmunization in the RHD negative recipient. The D negative phenotype is characterized by the absence of the D antigen (RH1) on the surface of the erythrocyte. Three main mechanisms can generate this absence: total or partial deletion of the RHD gene, insertion of base pairs within the said gene and gene conversion. The objective of this study was to report the first data on RHD genotyping in RHD negative congolese blood donors. Materials and Methods: Blood samples came from regular RHD-negative blood donors selected from the blood transfusion stations in Brazzaville and Pointe-Noire. They were analyzed individually by conventional PCR, targeting exons 4, 5, 7 and 10 of the RHD gene. Results: Fifty-nine regular RHD negative blood donors were selected for this study. The immuno-hematological profile was determined individually, and the dccee phenotype was the most frequent (n = 52;88.1%). The search for the weak D antigen was negative for all donors. Exons 4, 5, 7 and 10 of the RHD gene were amplified in the following respective proportions: 89.8%, 81.4%, 6.8% and 42.4%. Moreover, (1) donor was found to carry all four specific exons sought. Conclusion: Conventional PCR amplification allowed to study the presence of specific exons of the targeted D gene. At least one exon was detected in the entire study population. These results suggest that the RHD gene is indeed present in the donors studied and that the deletion cannot be considered as the main mechanism causing the RH-1 (D negative) phenotype in this sample.展开更多
R H是目前44个人类红细胞血型系统中除ABO血型外,最复杂、最富多态性的血型系统,D抗原是其中免疫原性最强的,红细胞上无D抗原为RHD阴性(简称RH-)血型。RH-人群的比例差异较大,欧美人群约占15-17%,非洲人群约占3-10%,我国及其他东南亚人...R H是目前44个人类红细胞血型系统中除ABO血型外,最复杂、最富多态性的血型系统,D抗原是其中免疫原性最强的,红细胞上无D抗原为RHD阴性(简称RH-)血型。RH-人群的比例差异较大,欧美人群约占15-17%,非洲人群约占3-10%,我国及其他东南亚人群比例少约占0.3-0.4%。RH-在我国虽属稀有血型,但根据其人群的分布特点和遗传规律,我国的RH-孕妇分娩RH+胎儿的概率反而极高;且随着我国近年来多胎生育政策的逐步开放,RH-妇女再次妊娠率逐年增加,RH-血的用血需求也相应增加。上述情况增加了母婴RH血型不合的风险,进而增加了胎儿/新生儿免疫溶血性疾病 (简称HDFN)的风险,HDFN发病早、进展快、病情严重、并发症风险高,严重威胁围产儿的生命健康、影响患儿远期生活质量,因此规范RH-孕产妇的围孕期管理尤为重要。但目前我国尚无统一、权威的管理指南,故本文综合了国内外相关文献,总结了围产保健方向的RH-孕产妇的围孕期管理规范要点,供临床产科医生参考,以降低HDFN发生率、围产儿死亡率、提高母婴保健质量。展开更多
文摘目的 通过对RhD阴性孕产妇腹中胎儿和分娩的新生儿发生胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)的相关指标对比分析,为预防和治疗HDFN提供参考和指导。方法 收集我院2018年1月—2022年12月分娩的RhD阴性孕产妇737名,比较新生儿是否发生RhD血型不合、ABO血型不合导致的HDFN及其影响因素,发生RhD-HDFN和发生ABO-HDFN的相关影响因素。分析发生RhD-HDFN和发生ABO-HDFN患儿的实验室指标差异;分析IgG抗-D效价≤16和≥32的孕产妇分娩的新生儿发生RhD-HDFN的实验室指标差异。结果 737名RhD阴性孕产妇中,发生RhD-HDFN的母婴ABO血型相同或相容者比率88.89%(40/45)显著高于母婴ABO血型不相容者11.11%(5/45)。母体二次妊娠及以上发生RhD-HDFN比率93.33%(42/45)显著高于ABO-HDFN 60.66%(37/61)者。母体IgG抗-D效价≥32者分娩的新生儿血红蛋白(hemoglobin,Hb)最低值低于母体IgG抗-D效价≤16者(χ^(2)=5.61,P<0.05),母体IgG抗-D效价≥32者分娩的新生儿血清总胆红素(total bilirubin,TBil)峰值高于IgG抗-D效价≤16者(χ^(2)=4.471,P<0.05)。结论 RhD阴性孕产妇中,母婴ABO血型相同或相容及孕产次≥2者,相应新生儿更易发生RhD-HDFN,母体IgG抗-D效价≥32者发生新生儿溶血的严重程度显著高于抗-D效价≤16者。
文摘Background: The D antigen is the most important and immunogenic antigen of the Rh blood group;its correct screening prevents any risk of alloimmunization in the RHD negative recipient. The D negative phenotype is characterized by the absence of the D antigen (RH1) on the surface of the erythrocyte. Three main mechanisms can generate this absence: total or partial deletion of the RHD gene, insertion of base pairs within the said gene and gene conversion. The objective of this study was to report the first data on RHD genotyping in RHD negative congolese blood donors. Materials and Methods: Blood samples came from regular RHD-negative blood donors selected from the blood transfusion stations in Brazzaville and Pointe-Noire. They were analyzed individually by conventional PCR, targeting exons 4, 5, 7 and 10 of the RHD gene. Results: Fifty-nine regular RHD negative blood donors were selected for this study. The immuno-hematological profile was determined individually, and the dccee phenotype was the most frequent (n = 52;88.1%). The search for the weak D antigen was negative for all donors. Exons 4, 5, 7 and 10 of the RHD gene were amplified in the following respective proportions: 89.8%, 81.4%, 6.8% and 42.4%. Moreover, (1) donor was found to carry all four specific exons sought. Conclusion: Conventional PCR amplification allowed to study the presence of specific exons of the targeted D gene. At least one exon was detected in the entire study population. These results suggest that the RHD gene is indeed present in the donors studied and that the deletion cannot be considered as the main mechanism causing the RH-1 (D negative) phenotype in this sample.
