【摘要】 目的探讨血型免疫球蛋白G(IgG)抗体效价与脐血溶血3项联合应用于新生儿ABO溶血病(ABOHDN)早期诊断中的效能。方法回顾性分析2016年3月至2018年6月深圳市龙华区人民医院收治的定期产检并正常分娩的O型血孕妇160例的临床资料,且与丈夫ABO血型均不合。分别对母血进行血型IgG抗体效价检测、对脐血进行溶血3项检测。以新生儿静脉血溶血3项及临床表现为诊断依据,判断ABO-HDN的发生情况。对比ABO-HDN发生者和未发生者母血血型IgG抗体效价检测结果、脐血溶血3项检测结果,分析不同方法对新生儿溶血病早期诊断的价值探讨。结果 160例受试者中共有75例发生ABO-HDN,发生率为46.88%; ABO-HDN发生者和未发生者血型IgG抗体效价检测结果分布对比差异有统计学意义(P <0.05),且前者≥1∶64者构成比明显高于后者,差异有统计学意义(P <0.05); ABO-HDN发生者脐血溶血3项阳性率均高于未发生者,差异有统计学意义(P <0.05),且ABOHDN发生者诊断阳性率高于高于未发生者,差异有统计学意义(P <0.05)。血型IgG抗体效价联合脐血溶血3项诊断早期ABO-HDN的特异度、准确度、阳性预测值和正确指数分别为97.65%、93.13%、97.06%、0.8565,均高于单独诊断,且灵敏度与血型IgG抗体效价相同,阴性预测值高于血型IgG抗体效价。结论 ABO-HDN在夫妻血型不合中的患病率高,将母体外周血血型IgG抗体效价与脐血溶血3项联合应用的诊断效能较高,有助于早期诊断。更多还原

【Abstract】 Objective To explore the efficacy of combined application of blood group immunoglobulin G( IgG) antibody titer and cord blood hemolysis in early diagnosis of ABO hemolytic disease of newborn( ABO-HDN). Methods The clinical data of 160 pregnant women with type O blood who were admitted to the People’s Hospital of Longhua District,Shenzhen,from March 2016 to June 2018,for regular obstetric examination and normal delivery were retrospectively analyzed. And the clinical data were inconsistent with their husbands’ ABO blood type. The titer of IgG antibody in maternal blood group and hemolysis in umbilical cord blood were tested respectively. The occurrence of ABO-HDN was judged on the basis of diagnosis of three items of intravenous hemolysis and clinical manifestations in neonates. The results of IgG antibody titers in maternal blood group and cord blood hemolysis in ABO-HDN patients and non-ABO-HDN patients were compared,and the value of different methods in early diagnosis of hemolytic disease of newborn was analyzed. Results There were 75 cases of ABO-HDN in 160 subjects,the incidence was46. 88%. There was a significant difference in the distribution of IgG antibody titers between ABO-HDN patients and non-ABO-HDN patients( P < 0. 05),and the proportion ≥ 1: 64 of the former was significantly higher than that of the latter,the difference was statistically significant( P < 0. 05). The three positive rates of cord blood hemolysis in ABO-HDN patients were higher than those in non-ABO-HDN newborns,the differences were statistically significant( P < 0. 05),and the positive rate of diagnosis of ABO-HDN was higher than that of non-ABO-HDN,the difference was statistically significant( P < 0. 05). The specificity,accuracy,positive predictive value and correct index of blood group IgG antibody titer combined with cord blood hemolysis in early diagnosis of ABO-HDN were 97. 65%,93. 13%,97. 06% and 0. 8565,respectively,which were higher than those of single diagnosis,and the sensitivity was the same as that of blood group IgG antibody,and the negative predictive value was higher than that of blood group IgG antibody. Conclusion The incidence of ABO-HDN in blood group incompatibility between husband and wife is high. The combined application of IgG antibody titer of maternal peripheral blood group and cord blood hemolysis has higher diagnostic efficiency,which is helpful for early diagnosis.更多还原