【摘要】 目的 分析本院产科1 040例ABO系统胎儿新生儿溶血病(hemolytic disease of fetus and newborn, HDFN)检测结果及其影响因素。方法 回顾性分析本院产科2022年9月—2023年1月期间送检的1 040例新生儿及其母亲血液标本相关检测结果，包括母子ABO血型、RhD血型以及新生儿溶血3项试验、Hb、总胆红素(TBIL)和间接胆红素(IBIL)。收集母子相关临床资料，包括母子年龄、新生儿性别、母亲孕产史、孕周和分娩方式等，并分析其对HDFN发生的影响。结果 1 040例HDFN检测标本中，ABO血型不合298例，其中113例HDFN阳性，阳性率为37.9%(113/298);母亲为O型者HDFN阳性率显著高于A和B型者(71.4%vs 8.2%,P<0.05);A型抗原不合者HDFN阳性率显著高于B型抗原不合者(48.7%vs 26.7%,P<0.05),且母子血型组合为O-A者最高，为83.6%(61/73),O-B次之，为58.2%(39/67)。除母子血型为O-A,HDFN阳性新生儿组Hb较HDFN阴性组低外[(145.0±16.0)vs(153.4±13.2),P<0.05],其余组间Hb和胆红素差异均无统计学意义；“直抗+间抗+放散+”组新生儿Hb、TBIL和IBIL水平较HDFN阴性组差异有统计学意义，分别为：(144.9±21.6)vs(153.3±13.2),(36.9±11.8)vs(29.6±6.1),(30.6±12.7)vs(23.0±6.9),P均<0.05。多因素Logistic回归分析结果显示，母亲分娩次数、母子不合抗原类型和母亲血型是影响HDFN发生的独立危险因素。结论 ABO-HDFN多发生于母亲为O型的新生儿，并且母子血型为O-A者阳性率最高；其严重程度与母-子血型关系不大，而与HDFN 3项试验检测结果关系较大；母亲分娩次数、母子不合抗原类型和母亲血型是影响其发生的独立危险因素。更多还原

【Abstract】 Objective To analyze ABO system hemolytic disease of the fetus and newborn(HDFN) and its influencing factors in Obstetrics Department of our hospital. Methods The blood samples of 1 040 neonates and their mothers in the obstetric department of our hospital were retrospectively analyzed from September 2022 to January 2023, including ABO and RhD blood group of the neonates and mothers, as well as 3 tests of HDFN, Hb, total bilirubin(TBIL) and indirect bilirubin(IBIL) of the neonates. Relevant clinical data of the neonates and mothers were collected, including maternal and neonatal age, neonatal sex, maternal pregnancy history, gestational age and delivery mode, and their influences on ABO-HDFN were analyzed. Results Among 1 040 HDFN samples, 298 were ABO incompatibility, among which 113 were HDFN positive, with a positive rate of 37.9%(113/298); the positive rate of HDFN in neonates born to mothers with type O was significantly higher than that in neonates born to mothers with type A and B(71.4% vs 8.2%, P<0.05);the positive rate of HDFN in neonates with antigen-A incompatibility was significantly higher than that in neonates with antigen-B incompatibility(48.7% vs 26.7%, P<0.05), which was the highest in neonates with O-A incompatibility[83.6%(61/73)], followed by O-B incompatibility[58.2%(39/67)]. There was no significant difference in Hb and bilirubin among the other groups except for the difference of Hb between the O-A incompatibility HDFN positive group and the HDFN negative group[(145.0±16.0) vs(153.4±13.2), P<0.05)]. The levels of Hb, TBIL and IBIL in the "direct antiglobulin test+ indirect antiglobulin test+release test+" group were significantly different from those in the HDFN negative group[(144.9±21.6) vs(153.3±13.2), P<0.05;(36.9±11.8) vs(29.6±6.1), P<0.05;(30.6±12.7) vs(23.0±6.9), P<0.05, respectively]. Logistic regression analysis showed that maternal delivery frequency, mother-neonate incompatible antigen and maternal blood type were independent risk factors for HDFN. Conclusion ABO-HDFN occurred mainly in neonates born to O-type mothers, and the positive rate was the highest in neonates with O-A incompatibility. The severity of HDFN had little relationship with the mother-neonate blood type, but had relationship with the result of 3 tests of HDFN. Maternal delivery frequency, mother-neonate incompatible antigen and maternal blood type were independent risk factors for HDFN.更多还原