摘要
目的分析ABO新生儿溶血(ABO-HDN)患儿血浆游离及红细胞放散抗体IgG1、IgG3亚型对新生儿溶血程度的影响,为临床早期诊断治疗提供参考。方法对本院2019年6月2020年3月新生儿科49例ABO-HDN患儿进行溶血3项检测的同时,进行血浆和放散抗体液IgG1、IgG3分型检测,再结合患儿出生小时数(生理黄疸)与患儿溶血程度因素(总胆红素、间接胆红素、血红蛋白)进行相关性分析。结果在进行放散抗体IgG1、IgG3亚型检测的44例患儿组中,患儿总胆红素、间接胆红素与患儿出生小时数可以建立回归方程,患儿血红蛋白与抗体释放结果可以建立回归方程,并均呈线性回归关系(P<0.05);进行血浆抗体IgG1、IgG3亚型检测的28例患儿组中,患儿总胆红素、间接胆红素与患儿出生时间及血浆抗体IgG3亚型可以建立回归方程,患儿血红蛋白与患儿血浆抗体IgG1亚型结果可以建立回归方程(P<0.05),并均有线性回归关系(P<0.05);在2组分析中观察到ABO-HDN 3项试验全阴,检测出gG1、IgG3亚型抗体的3例患儿均为二胎,最后诊断Rh-HDN 2例,其他系统HDN 1例。结论患儿溶血程度直接与血浆中的IgG1、IgG3抗体有关,在评价诊断和治疗效果中除总胆红素、间接胆红素情况外应监测患儿血浆IgG3抗体变化,在观察患儿贫血情况时也应监测患儿血浆IgG1抗体,在ABO-HDN溶血3项全阴情况下检测出IgG1、IgG3抗体,应及时考虑除ABO系统外的新生儿溶血病,做到精准诊断、精准治疗。
Objective To analyze the effects of IgG subtypes(IgG 1 and IgG3) of antibodies contained in infant serum and erythrocyte eluates on hemolytic disease of the newborn(HDN), so as to provide reference for its early clinical diagnosis and treatment. Methods 49 newborns with HDN in our hospital from June 2019 to March 2020 were detected for three hemolytic tests(direct antiglobulin test, elution test and indirect antiglobulin test), as well as the components of IgG1 and IgG3 in eluates. The correlation analysis was conducted by combining birth hours(physiological jaundice) and hemolytic degrees(total bilirubin, indirect bilirubin, and hemoglobin). Results In the 44 cases of IgG1 and IgG3 subtype detection of infant RBC eluates, regression equations could be established between total bilirubin, indirect bilirubin and birth hours, and between hemoglobin and elution test, and linear regression relationships were found(P<0.05). In the 28 cases of IgG1 and IgG3 subtype detection of infant serum, regression equations could be established between total bilirubin, indirect bilirubin, birth time and IgG3 subtype, and between hemoglobin and IgG1 subtype(P<0.05), and linear regression relationships were found(all P<0.05). Three infants, presenting IgG1 and IgG2 subtypes(+) and three hemolysis tests(-), were all second pregnancy, constituted by Rh-HDN of 2 case and other-system-HDN 1.Conclusion The degree of HDN is directly related to IgG1 and IgG3 antibodies in infant blood plasma. In addition to the total bilirubin and indirect bilirubin, the changes of IgG3 antibodies in infant plasma and IgG1 antibody in anemic infants should be monitored. If IgG1 and IgG3 antibodies are yielded even with all negative ABO-HDN hemolysis tests, non-ABO-HDN should be considered in time to achieve accurate diagnosis and treatment.
作者
杨劲
储节华
曹明鹏
李凌波
钟靖
YANG Jin;CHU Jiehua;CAO Mingpeng;LI Lingbo;ZHONG Jing(Department of Blood Transfusion,Hefei Second Peopled Hospital of Anhui Province,Hefei 230011,China;K&D Department of Changchun Boxun Biotechnology Co.,Ltd.;Department of Blood Transfusion,Shaoyang Central Hospital of Hunan Province)
出处
《中国输血杂志》
CAS
2021年第6期624-627,共4页
Chinese Journal of Blood Transfusion
基金
吉林省科技厅科技发展计划资助项目(20160204016SF)
合肥市第二人民医院科研项目(2020-65-8)。
关键词
溶血3项
血浆IgG1、IgG3抗体
溶血程度
回归方程
three hemolysis items
plasma IgG1 and IgG3 antibodies
degree of hemolysis
the regression equation
