【摘要】 目的分析304例RhD阴性孕产妇RhD同种免疫发生情况,探讨RhD阴性孕产妇抗D抗体产生的影响因素,建立正确的围产期孕妇RhD新生儿溶血病监测方案。方法采用标准血清学方法对孕产妇及其丈夫进行ABO及RhD抗原鉴定。对RhD抗原鉴定为阴性的样本,进一步采用间接抗人球蛋白法检测RhD抗原,以排除或确认弱D型或部分D表型。对所有RhD阴性孕产妇及其丈夫进行RhCcEe表型的血清学分型。采用抗人球蛋白法对所有RhD阴性孕产妇标本进行不规则抗体初筛,对初筛阳性者进一步用鉴定细胞做抗体鉴定及抗体效价测定并采用PCR-SSP方法确定是否为Del型。结果 3975例孕产妇标本中,304例为RhD阴性,其中29例产生抗D抗体,夫妇ABO血型相合24例(82.76%),不合5例(17.24%)。本组调查中Rh阴性孕产妇抗D抗体产生的比例为9.54%(29/304)。经分子生物学方法鉴定,29例产生抗D的Rh阴性孕产妇均排除Del表型。结论 RhD阴性孕产妇RhD同种免疫的发生受多种因素影响,Del型孕产妇产生抗D概率较低。应及时、定期监测RhD阴性围产期孕妇的抗D水平。对已产生抗D抗体的孕妇,密切监测其抗D水平,为临床治疗方案提供依据。更多还原

【Abstract】 Objective To analyze the RhD isoimmunization state of 304 RhD-negative pregnant and lying-in women, explore factors which affect production of the anti-D antibody in them,and set up a correct prenatal testing method for RhD haemolytic disease of the fetus and newborn. Methods ABO and RhD blood types of pregnant and lying-in women and their husbands were identified by the standard serological method. For RhD-negative women,the D antigen was further tested with the indirect antiglobulin test to exclude or confirm weak D or partial D types. The RhC,c,E and e antigens were typed in all RhD-negative women and their husbands. The irregular antibody was screened in all RhD-negative women,and if the result was positive,the specificity and titer of the antibody were determined. At the same time,if phenotypes of the RhD-negative women with the anti-D antibody were Del type or not was determined with the PCR-SSP method. Results Among 3,975 pregnant and lying-in women,304 were confirmed to be RhD-negative,of whom 29 produced the anti-D antibody; 24 carried compatible ABO antigens with their husbands ( 82. 76% ) ; 5 carried incompatible ABO antigens with their husbands( 17. 24% ) . The production rate of the RhD antibody in D-negative pregnant and lying-in women was 9. 54% ( 29 /304) . All 29 RhD-negative women with anti-D were excluded from carrying the Del phenotype with the molecular biological method. Conclusions RhD isoimmunization is affected by many factors. Pregnant women with the Del type seldom produce the anti-D antibody. The anti-D level should be timely and regularly tested among pregnant women. For women who have produced the anti-D antibody,the antibody level should be closely detected during pregnancy,which will provide evidence for clinical treatment.更多还原