摘要
探讨新生儿溶血病(HDN)血清学检测与其相关影响因素之间的关系,观察母婴血型不合新生儿溶血病(HDN)红细胞血型免疫性抗体的检出率及其特异性。方法:先检测母婴血型,然后采用直接抗人球蛋白试验、游离抗体试验、释放试验检测是否发生HDN,对怀疑存在除ABO以外的溶血病或直接抗人球试验结果达2+以上者,采用不规则抗体筛查细胞与患儿血清和母亲血清进行间接抗球蛋白试验,并进一步鉴定抗体,验证患儿红细胞是否存在相应抗原,证实是否存在其他血型系统的溶血病。采用SPSS 22.0软件进行分析,分类资料统计分析采用χ~2检验, P<0.05为差异有统计学意义。结果:本研究共收集的501例高胆红素血症患儿标本,确诊为HDN的有250例,检出率为49.90%。男性患儿检出率为45.14%,女性患儿检出率为56.34%,差异具有统计学意义(χ~2=6.143, P <0.05)。患儿平均日龄为3.97±2.81 d,HDN检出率与患儿日龄的关系分析显示,患儿日龄对HDN检出率有影响(χ~2=63.489,P <0.05)。各日龄分组HDN+患儿3项试验结果阳性率分析发现,直接抗人球试验检出率有显著差异(χ~2=18.976,P <0.05),游离抗体试验的检出率亦有显著差异(χ~2=9.650,P <0.05),释放试验阳性率最高(100%)。本研究中244例是ABO溶血,其中1例ABO溶血合并Rh系统(抗-E)溶血,4例由Rh系统(抗-D)引起,2例由MN系统(1例由抗-M,1例为低频率的抗-Mur)引起。抗-A与抗-B引起ABO HDN没有统计学意义(χ~2=0.889,P> 0.05)。结论:母婴血型不合新生儿溶血病是新生儿高胆红素血症的常见原因之一,患儿的性别和日龄对HDN检出率有影响,抗-A和抗-B对HDNen检出率无显著差异。为避免抗体漏检造成HDN诊断错误,必要时应进行不规则抗体筛查和鉴定。
Objective: To explore the relationship between the serological detection of neonatal hemolytic disease(HDN) and related factors, and to observe the detection rate and specificity of the antibodies against the blood group in the newborn hemolytic disease. Methods: Maternal-neonatal blood type was detected firstly, and then the direct antiglobulin test(DAT), the free antibody test and the antibody release test were used to detect the occurrence of HDN;For those suspected hemolytic disease except ABO or direct DAT result over 2+, the indirect antiglobulin test with irregular antibody were used for screening cells and the plasma of the patient and mother, and then to detezmine whether there is a corresponding antigen in the red blood cells of the patient to confirm whether hemolytic disease of the other blood type system exists or not. The analysis was carried out by SPSS 22 software. The statistical analysis of classified data was tested by χ^2test. P <0.05 was considered as statistically significance. Results: A total of 501 cases of hyperbilirubinemia were collected. Among them 250 cases of HDN were diagnosed as HDN, and the detection rate was 49.90%.The detection rate of the male was 45.14%, and that of the female was 56.34%(χ^2=6.143, P <0.05). The average day-age of patients was 3.97±2.81 days. The analysis of relatianship between the detected rate of HDN and the day-age of HDN chilren showed that the day-age of HDN chilren affected the detected rate of HDN(χ^2=63.489, P<0.05). The analysis of positive rate of 3 test in HDN+ childen of every group found that the day-age had an infuence on the detected rate of direct antiglobulin test(χ^218.976,P <0.01) and also had an influence on the detected rate of the free antibody test(χ^29.650,P <0.05). The positive rate of the release test in HDN patients was highest(100%). 244 cases suffered from ABO hemolysis, including 1 case of ABO hemolysis combined with Rh system(anti-E) hemolysis, 4 cases of Rh system(anti-D), 2 cases of MN system(1 case was caused by anti-M, 1 case was caused by low frequency anti-Mur). ABO HDN caused by anti-A or anti-B were not statisticaly significant. Conclusion: Hemolytic disease of the newborn is a common cause of neonatal hyperbilirubinemia. The positive rate of HDN has a certain relations with the sexual distinction and the day-age. But there is no significant difference between anti-A and anti-B type. At the same time, screening and identification of irregular antibodies should be carried out to avoid diagnostic errors caused by undetected antibody when necessary.
作者
杨璇
陈富臻
洪强
YANG Xuan;CHEN Fu-Zhen;HONG Qiang(Department of Blood Transfusion,The First Affiliated Hospital of Xiamen University,Xiamen 36100,Fujian Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2019年第1期192-196,共5页
Journal of Experimental Hematology
关键词
新生儿溶血病
直接抗人球试验
游离抗体试验
释放试验
不规则抗体筛查
neonatal hemolytic disease
direct antiglobulin test
free antibody test
antibody release test
irregular antibody screening
