【摘要】 目的 回顾性分析474例高胆红素血症新生儿的临床资料，探讨ABO胎儿新生儿溶血病（hemolytic disease of the fetus and newborn, ABO-HDFN）所致高胆红素血症的临床特征及蓝光治疗影响因素。方法 本研究纳入2019年1月至2023年1月期间在兰州大学第一医院接受治疗的474例高胆红素血症新生儿作为研究对象。所有患儿均接受血型鉴定及新生儿溶血三项试验。收集并分析其基线临床资料。根据溶血三项试验结果，将患儿分为溶血性黄疸组和非溶血性黄疸组。对2组患儿的血红蛋白水平、住院时间及蓝光治疗持续时间等临床指标进行比较分析。同时，采用多元线性回归模型探讨影响蓝光治疗时间的相关临床因素。结果 474例高胆红素血症新生儿中，354例确诊为ABO-HDFN（溶血病组）,120例未发生ABO-HDFN（非溶血病组）。A型新生儿中ABO-HDFN发生率（55.93%,198/354）高于B型新生儿（44.07%,156/354）,差异有统计学意义（P<0.05）。此外，二胎及以上新生儿ABO-HDFN发生率（81.56%,146/179）高于首胎新生儿（70.51%,208/295）,差异有统计学意义（P<0.05）。溶血病组患儿的血红蛋白水平（170.67±21.86）g/L低于非溶血病组（178.99±22.05）g/L（P<0.001）,红细胞计数（4.66±0.63）×10¹²/L低于非溶血病组（4.89±0.59）×10¹²/L（P<0.05）,红细胞压积（50.05±6.56）%低于非溶血病组（52.61±6.75）%（P<0.05）。溶血病组患儿的住院天数[6（5,9）d]、蓝光治疗时间[62（38,84.25）h]及黄疸发病次数[9（7,13）次]均高于非溶血病组[住院天数6（4,8）d、蓝光治疗时间53（34.25,64.77）h、黄疸发病次数8（6,12）次],差异均有统计学意义（P值均<0.05）。回归分析显示，游离抗体试验阳性及胎次（二胎及以上）是蓝光治疗时间延长的独立危险因素（P<0.05）。结论 ABO血型不合是新生儿溶血病的主要病因，应对母亲为O型、新生儿为A型者，加强对该人群胆红素水平的动态监测。多次妊娠增加了同种免疫性溶血风险，临床应针对二胎及以上新生儿缩短胆红素监测间隔，并在必要时开展产前干预措施。同时，应重视血红蛋白水平、红细胞计数等指标的变化对溶血性贫血及胆红素升高的预警作用。更多还原

【Abstract】 Objective To retrospectively analyze the clinical data of 474 newborns with hyperbilirubinemia, and to investigate the clinical characteristics of hyperbilirubinemia caused by ABO hemolytic disease of the fetus and newborn（ABO-HDFN） and factors influencing the phototherapy duration. Methods A total of 474 neonates with hyperbilirubinemia treated in the First Hospital of Lanzhou University from January 2019 to January 2023 were enrolled. Blood type identification and the standard serological tests（direct antiglobulin test, serum free antibody test, and antibody elution test） were performed for all neonates. Baseline clinical data were collected and analyzed. According to the results of the hemolysis tests, neonates were divided into hemolytic jaundice group and non-hemolytic jaundice group. Clinical indicators, including hemoglobin levels, length of hospital stay, and phototherapy duration, were compared between the two groups.A multiple linear regression model was used to explore clinical factors influencing the duration of phototherapy. Results Among the 474 neonates with hyperbilirubinemia, 354 were diagnosed with ABO-HDFN（hemolytic group）, while 120 were without ABO-HDFN（non-hemolytic group）.The incidence of ABO-HDFN in neonates with blood type A（55.93%,198/354）was significantly higher than those with blood type B（44.07%,156/354）（P<0.05）.Furthermore, neonates born to multiparous women had a significantly higher ABO-HDFN incidence（81.56%, 146/179） than first-born neonates（70.51%, 208/295）（P<0.05）.Neonates in the hemolytic group had significantly lower hemoglobin levels（170.67±21.86 g/L vs 178.99±22.05 g/L, P<0.001）, lower red blood cell counts(4.66±0.63×10¹²/L vs 4.89±0.59×10¹²/L, P<0.05), and lower hematocrit（50.05±6.56% vs 52.61±6.75%, P<0.05） compared to the non-hemolytic group. Additionally, the hemolytic group had significantly longer hospital stays（6 [5,9] days vs 6 [4,8] days）, longer phototherapy duration（62 [38,84.25] h vs 53 [34.25,64.77] h）, and higher frequency of jaundice episodes(9 [7,13] times vs 8 [6,12] times] compared to the non-hemolytic group（all P<0.05）. Regression analysis indicated that a positive indirect Coombs test and multiparity were independent risk factors associated with prolonged phototherapy duration（P<0.05）. Conclusion ABO incompatibility is the leading cause of hemolytic disease in neonates, particularly in cases where the mother has blood type O and the neonate has blood type A. In such cases, close monitoring of bilirubin levels is strongly recommended. Multiparous pregnancies increase the risk of alloimmune hemolysis. Therefore, neonates born to multiparous women may require more frequent bilirubin monitoring and appropriate prenatal interventions when necessary. Additionally, changes in indicators such as hemoglobin level and red blood cell count should be closely monitored as early warning indicators for hemolytic anemia and bilirubin elevation.更多还原