摘要
目的观察流式细胞术检测脐带血及溶血三项（游离抗体试验、抗体释放试验、直接抗人球蛋白试验）对新生儿ABO溶血病的诊断价值.方法纳入2015年8月至2017年8月在本院分娩的84例新生儿（与母亲ABO血型不合）为对象,开展回顾性分析.采集脐带血及外周静脉血,检测RH、ABO血型及经皮胆红素水平,采用流式细胞术检测致敏红细胞,并行溶血三项检测,观察外周静脉血溶血三项与脐带血、外周静脉血流式细胞术检测结果.结果84个样本中外周静脉血溶血三项检出阳性68个,阴性16个;外周静脉血流式细胞术检测阳性56个,阴性28个,诊断灵敏度为82.35%,特异度为100.00%,诊断准确率为85.71%,阳性预测值为100.00%,阴性预测值为57.14%,Kappa值为0.64;脐带血流式细胞术检测阳性59个,阴性25个,诊断灵敏度为86.76%,特异度为100.00%,诊断准确率为89.29%,阳性预测值为100.00%,阴性预测值为64.00%,Kappa值为0.71.脐带血流式细胞术检测诊断灵敏度、准确率虽稍高于外周静脉血流式细胞术检测,但两项检查方式诊断准确率、灵敏度比较,差异无统计学意义（P〉0.05）.脐带血流式细胞术检测阳性反应细胞百分比为（29.26±15.44）%,外周静脉血阳性反应细胞百分比为（25.08±14.92）%,2种血标本检测结果比较,差异无统计学意义（P〉0.05）.经ROC曲线处理,结果显示脐带血与外周静脉血流式细胞术检测阳性反应细胞百分比对新生儿ABO溶血病均有-定预测价值,曲线下面积分别为0.958、0.898,敏感度分别为0.917、0.857,特异度分别为0.905、0.786.结论联合溶血三项、流式细胞术检测新生儿ABO溶血病灵敏度、特异度高,对该病早期诊治具有重要临床价值.
Objective To observe the diagnostic value of umbilical cord blood by fow cytometry and three hemolytic tests （free antibody test, antibody release test, direct anti human globulin test） in ABO hemolytic disease of the newborn. Methods A retrospective analysis was carried out in 84 newborns delivered in our hospital from August 2015 to August 2017 （incompatible with the mothers＇ ABO blood group）. The umbilical cord blood and peripheral venous blood were collected. RH, ABO blood group, and the level of percutaneous bilirubin were detected. The sensitized erythrocyte was detected by fow cytometry. Three hemolytic tests were performed. The results of three hemolytic tests of peripheral venous blood, the test results of umbilical cord blood and peripheral venous blood by fow cytometry were observed. Results There were 68 positive cases of three hemolytic tests of peripheral venous blood in the 84 cases, and 16 negative cases. There were 56 positive cases of peripheral venous blood by fow cytometry, and 28 negative cases, the diagnostic sensitivity was 82.35%, the specifcity was 100.00%, the diagnostic accuracy was 85.71%, the positive predictive value was 100.00%, the negative predictive value was 57.14%, and the Kappa value was 0.64. There were 59 positive cases of umbilical cord blood by fow cytometry, and 25 negative cases, the diagnostic sensitivity was 86.76%, the specifcity was 100.00%, the diagnostic accuracy was 89.29%, the positive predictive value was 100.00%, the negative predictive value was 64.00%, and the Kappa value was 0.71. The diagnostic sensitivity and accuracy of umbilical cord blood by fow cytometry were slightly higher than those of peripheral venous blood by fow cytometry, but without statistically signifcant differences between the two examination methods （P〉0.05）. The positive cells percentage of umbilical cord blood by fow cytometry was （29.26±15.44）%, that of peripheral venous blood by fow cytometry was （25.08±14.92）%, without statistically signifcant difference （P〉0.05）. The ROC curve result showed that the positive cells percentagesvalue was 64.00%, and the Kappa value was 0.71. The diagnostic sensitivity and accuracy of umbilical cord blood by fow cytometry were slightly higher than those of peripheral venous blood by fow cytometry, but without statistically signifcant differences between the two examination methods （P〉0.05）. The positive cells percentage of umbilical cord blood by fow cytometry was （29.26±15.44）%, that of peripheral venous blood by fow cytometry was （25.08±14.92）%, without statistically signifcant difference （P〉0.05）. The ROC curve result showed that the positive cells percentages of umbilical cord blood and peripheral venous blood by fow cytometry had certain predictive value in neonatal ABOhemolytic disease, the area under the curve were 0.958, 0.898 respectively, the sensitivity were 0.917, 0.857 respectively, the specifcity were 0.905, 0.786 respectively. Conclusion Flow cytometry combined with three hemolytic tests has high sensitivity and specifcity in the diagnosis of ABO hemolytic disease of the newborn, of great value for the early diagnosis and treatment of the disease.
作者
唐晓春
Tang Xiaochun(Department of Blood Transfusion, Huangdao District Hospital of Traditional Chinese Medicine, Qingdao, Qingdao 266500, Chin)
出处
《国际医药卫生导报》
2018年第9期1428-1431,共4页
International Medicine and Health Guidance News
关键词
流式细胞术
脐带血
溶血三项
新生儿
ABO溶血病
Flow cytometry
Umbilical cord blood
Three hemolytic tests
Newborn
ABO hemolytic disease
