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孕妇血型IgG抗体效价与新生儿溶血病发病率关系的研究

发布时间:2019-01-10 17:57
【摘要】:研究目的: 分析O型血孕妇不同妊娠次数对发生新生儿ABO溶血病(ABOhemolytic disease of newborn, ABO-HDN)的影响;并探讨O型血孕妇IgG抗体效价与新生儿溶血病(HDN)发生率及溶血程度的关系以及ABO-HDN的血型分布情况与发生ABO-HDN的关系。 研究方法: 收集2012年11月至2015年1月26个月期间吉林省妇幼保健院收治的符合入选标准(排除孕妇不规则抗体检测阳性、没有输血记录、肝肾功能正常、无其他血液疾病,并且新生儿为足月生产)O血型孕妇(丈夫为非O血型)725例,其中发生ABO-HDN的有116例。对以上病例进行总结并分析:首先把孕妇妊娠次数分成首次妊娠组和非首次妊娠组,分别是382例和343例,比较孕妇不同妊娠次数对发生新生儿ABO溶血病的影响;其次根据孕妇丈夫ABO血型分为妻夫O-A血型组、妻夫O-B血型组和妻夫O-AB血型组,其中O-A血型组为284例,O-B血型组为265例,O-AB血型组176例,探讨夫妇血型不合与发生ABO-HDN的相关性;最后动态监测O型血孕妇抗体效价,通过测定溶血三项试验及间接胆红素的浓度来分析孕妇抗体效价与HDN的关系。 研究结果 首次妊娠组中患新生儿溶血病的效价为≤1:64的有0例,效价1:128的有8例(8/26),效价1:256的有9例(9/20),效价1:512的有2例(2/4),效价〉1:512的有2例(2/3);非首次妊娠组中患新生儿溶血病的效价为≤1:64组的有0例,效价1:128的有32例(32/78),效价1:256的有26例(26/46),,效价1:512的有24例(24/28),效价1:512的有13例(13/13); 妻夫血型为O-A血型组为284例,O-B血型组为265例,O-AB血型组176例,其中O-A型、O-B型和O-AB型发生ABO-HDN的分别占30.6%(87/284)、28.3%(75/265)及33.0%(58/176),差异无统计学意义(P0.05); IgG抗A(B)抗体不同效价组中母婴ABO血型不合例数分别为1:64组377例、1:64组130例、1:128组104例、1:256组66例、1:512组32例及1:512组16例,且ABO-HDN的阳性率分别为0(0/0)、0(0/0)、38.5%(40/104)、53%(35/66)、81.3%(26/32)、和93.8%(15/16),差异有统计学意义(P0.05)。产前检查孕妇抗体效价结合分娩后患病的新生儿血清间接胆红素浓度,发现随母体血型抗体效价的升高,患儿血清间接胆红素水平有升高趋势。 结论: 非首次妊娠的孕妇的ABO-HDN的发生率要比首次妊娠的孕妇发生率要高;ABO-HDN的发生概率与患病程度与孕妇体内抗体效价呈正相关。同时也与患儿血清间接胆红素水平呈正相关;而ABO-HDN的发生与孕妇丈夫的血型无明显关系。因此,为减少溶血程度,避免胆红素脑病甚至死亡的发生,对于非首次妊娠及孕妇抗体效价较高1:64的孕妇临床应该连续监测,密切关注。
[Abstract]:Objective: to analyze the effect of different pregnancy times on the occurrence of neonatal ABO hemolytic disease (ABOhemolytic disease of newborn, ABO-HDN) in type O blood pregnant women. The relationship between IgG antibody titer and (HDN) incidence and hemolytic degree of newborn hemolytic disease and the distribution of ABO-HDN blood group and occurrence of ABO-HDN were discussed. Methods: from November 2012 to January 2015, the patients admitted to Jilin Maternal and Child Health Hospital were collected to meet the selection criteria (excluding irregular antibodies of pregnant women tested positive, no blood transfusion records, normal liver and kidney function, There were 725 cases of pregnant women with O blood group (husband is non-O blood group), including 116 cases of ABO-HDN. Summary and analysis of the above cases: first, pregnant women were divided into first pregnancy group and non-first pregnancy group, 382 cases and 343 cases, respectively, to compare the influence of different pregnancy times on the occurrence of neonatal ABO hemolytic disease. Secondly, according to the ABO blood group of pregnant women, they were divided into two groups: husband O-A group, wife O-B group and wife O-AB group, including 284 cases in O-A group, 265 cases in O-B group and 176 cases in O-AB group. To explore the correlation between couple blood group incompatibility and ABO-HDN. Finally, the antibody titers of type O blood pregnant women were dynamically monitored, and the relationship between antibody titers and HDN was analyzed by measuring hemolysis test and indirect bilirubin concentration. Results in the first pregnancy group, the titer of hemolytic disease was less than 1:64 in 0 cases, 1: 128 in 8 cases (8 / 26), and 1: 256 in 9 cases (9 / 20). There were 2 cases (2 / 4) with titer of 1: 512 and 2 cases (2 / 3) with titer > 1: 512. In the non-first pregnancy group, the titer of hemolytic disease of newborn infants was less than 1:64 in 0 cases, 1: 128 in 32 cases (32 / 78), 1: 256 in 26 cases (26 / 46), and 1: 512 in 24 cases (24 / 28). There were 13 cases (13 / 13) with a titer of 1: 512; There were 284 cases of O-A blood group, 265 cases of O-B blood group and 176 cases of O-AB blood group. The incidence of ABO-HDN in O-A, O-B and O-AB was 30.6% (87 / 284), respectively. 28.3% (75 / 265) and 33.0% (58 / 176), the difference was not statistically significant (P0.05). There were 377 cases of maternal and infant ABO blood group incompatibility in different titers of IgG antibody against A (B) in 1:64 group, 130 cases in 1:64 group, 104 cases in 1: 128 group, 66 cases in 1: 256 group, 32 cases in 1: 512 group and 16 cases in 1: 512 group. And the positive rates of ABO-HDN were 0 (0 / 0), 0 (0 / 0), 38.5% (40 / 104), 53% (35 / 66), 81.3% (26 / 32), and 93.8% (15 / 16), respectively. The difference was statistically significant (P0.05). The antibody titer of pregnant women combined with the serum indirect bilirubin concentration after delivery showed that the serum indirect bilirubin level increased with the increase of maternal blood group antibody titer. Conclusion: the incidence of ABO-HDN in non-first-trimester pregnant women is higher than that in first-trimester pregnant women, and the incidence of ABO-HDN is positively correlated with the titer of antibodies in pregnant women. There was also a positive correlation between serum indirect bilirubin level and serum indirect bilirubin level, but there was no significant correlation between the occurrence of ABO-HDN and the blood group of husband. Therefore, in order to reduce the degree of hemolysis and avoid bilirubin encephalopathy or even death, clinical monitoring and close attention should be paid to the pregnant women whose antibody titers are higher than 1:64 in non-first-time pregnancy and pregnant women.
【学位授予单位】:吉林大学
【学位级别】:硕士
【学位授予年份】:2015
【分类号】:R446.6

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