摘要
目的 探讨分析孕妇血型抗体的种类及效价与新生儿溶血病 (HDN)发生率及溶血程度的关系 ,为HDN的确诊 ,病情预测和防治提供依据。方法 选择既往有不良妊娠史的孕妇 ,用血型定型试剂检测夫妇血型种类以确认夫妇血型不合。用抗人球蛋白实验方法检测孕妇分娩前血清中不同种类血型抗体的效价。对产后 3～ 7d出现黄疸症状的患儿做胎儿溶血三项实验 ,以确诊HDN。检测HDN患儿血清胆红素浓度 ,结合临床症状 ,将其分为轻重两组。观察分析血型抗体效价与HDN发生率及溶血受害程度的关系。选择轻重两组HDN患儿中对应产前已检测的母血清IgG抗A(B)效价≥ 5 12或IgG抗D效价≥ 64 ,临床预测可能发生重度HDN的母血清及正常对照组的母血清 ,用微量淋巴细胞毒实验检测抗丈夫HLA抗体 ,观察HLA抗体与HDN患儿轻重程度的相关性。结果 ⑴孕产妇血型抗体IgG效价≥ 64的例数在夫妇血型组合O -A ,O -B ,O -AB病例中所占比例分别为 68% ,64 % ,71% ,(P >0 0 5 )。⑵随IgG抗A(B)效价的递增 ,HDN发生率增加 ,且溶血程度加重 ,P <0 0 1。⑶Rh系统HDN占检测病例的 0 5 % ,且病情严重。⑷已发生HDN受害程度轻型组的母血清中HLA抗体产生率为 85 % ,溶血受害程度严重组的母血清中HLA抗体产生率为 47% ,两组差异非常显著 ,P <0 0 1,正?
Objectives To explore the relationship between the types and titers of maternal blood group antibodies and the incidence or severity of HDN to provide the basis for diagnosing, predicting and preventing HDN. Methods The pregnant women with abnormal pregnant history were enrolled in this study. The blood group typing reagent was used to define the types of maternal and paternal blood groups to confirm if pregnant women's blood groups were incompatible to their husbands' ones. The anti-human globulin test was applied to assay the titers of blood group antibodies in serum of prenatal women. The three hemolytic tests were designed to diagnose HDN in the newborn who had the symptom of jaundice. The newborns suffering from HDN were divided into the mild course group and the severe course group, according to the concentration of BIL and the clinical symptoms. Lymphocyte microcytotoxicity assay (LCA) was used to detect the serum HLA antibodies against their husbands in the pregnant women with titers of anti-A(B) antibodies of IgG type ≥ 512 and those of anti-D antibodies of IgG type ≥64. The relationship between the incidence of HLA antibodies and the severity of HDN was analyzed. Results ⑴The ratio of the pregnant women, whose titers of blood group antibodies ≥64 in O-A, O-B and O-AB groups was 68%, 64% and 71%, respectively (P>0.05).⑵ With the increase of titers of anti-A(B) antibodies of IgG type, both the incidence and severity of HDN elevated (P<0.01).⑶The incidence of HDN in Rh blood group system was 0.6%, but HDN was severe. ⑷The incidence of serum HLA antibodies in the mothers, whose newborns suffered from mild or severe HDN, was 85% and 47%, respectively, which had a significant difference between the two groups(P<0.01). The incidence of HLA antibodies in the mothers of control group was 30%. Conclusion The incidence and severity of HDN was related to the types and titers of prenatal antibodies of IgG type. The incidence of serum HLA antibodies in pregnant women against their husbands was related to the severity of HDN.
出处
《中国医师杂志》
CAS
2004年第10期1300-1302,共3页
Journal of Chinese Physician
