孕婦血型IgG抗體效價與新生兒溶血病發(fā)病率關(guān)系的研究
發(fā)布時間：2019-01-10 17:57
【摘要】：研究目的: 分析O型血孕婦不同妊娠次數(shù)對發(fā)生新生兒ABO溶血�。ˋBOhemolytic disease of newborn, ABO-HDN）的影響；并探討O型血孕婦IgG抗體效價與新生兒溶血�。℉DN）發(fā)生率及溶血程度的關(guān)系以及ABO-HDN的血型分布情況與發(fā)生ABO-HDN的關(guān)系。 研究方法: 收集2012年11月至2015年1月26個月期間吉林省婦幼保健院收治的符合入選標(biāo)準(zhǔn)（排除孕婦不規(guī)則抗體檢測陽性、沒有輸血記錄、肝腎功能正常、無其他血液疾病，并且新生兒為足月生產(chǎn)）O血型孕婦（丈夫為非O血型）725例，其中發(fā)生ABO-HDN的有116例。對以上病例進(jìn)行總結(jié)并分析：首先把孕婦妊娠次數(shù)分成首次妊娠組和非首次妊娠組，分別是382例和343例，比較孕婦不同妊娠次數(shù)對發(fā)生新生兒ABO溶血病的影響；其次根據(jù)孕婦丈夫ABO血型分為妻夫O-A血型組、妻夫O-B血型組和妻夫O-AB血型組，其中O-A血型組為284例，O-B血型組為265例，O-AB血型組176例，探討夫婦血型不合與發(fā)生ABO-HDN的相關(guān)性；最后動態(tài)監(jiān)測O型血孕婦抗體效價，通過測定溶血三項試驗及間接膽紅素的濃度來分析孕婦抗體效價與HDN的關(guān)系。 研究結(jié)果 首次妊娠組中患新生兒溶血病的效價為≤1：64的有0例，效價1：128的有8例（8/26），效價1：256的有9例（9/20），效價1：512的有2例（2/4），效價〉1：512的有2例（2/3）；非首次妊娠組中患新生兒溶血病的效價為≤1：64組的有0例，效價1：128的有32例（32/78），效價1：256的有26例（26/46），，效價1：512的有24例（24/28），效價1：512的有13例（13/13）； 妻夫血型為O-A血型組為284例，O-B血型組為265例，O-AB血型組176例，其中O-A型、O-B型和O-AB型發(fā)生ABO-HDN的分別占30.6%（87/284）、28.3%（75/265）及33.0%（58/176），差異無統(tǒng)計學(xué)意義（P0.05）； IgG抗A（B）抗體不同效價組中母嬰ABO血型不合例數(shù)分別為1:64組377例、1：64組130例、1：128組104例、1：256組66例、1：512組32例及1：512組16例，且ABO-HDN的陽性率分別為0（0/0）、0（0/0）、38.5%（40/104）、53%（35/66）、81.3%（26/32）、和93.8%（15/16），差異有統(tǒng)計學(xué)意義（P0.05）。產(chǎn)前檢查孕婦抗體效價結(jié)合分娩后患病的新生兒血清間接膽紅素濃度，發(fā)現(xiàn)隨母體血型抗體效價的升高，患兒血清間接膽紅素水平有升高趨勢。 結(jié)論: 非首次妊娠的孕婦的ABO-HDN的發(fā)生率要比首次妊娠的孕婦發(fā)生率要高；ABO-HDN的發(fā)生概率與患病程度與孕婦體內(nèi)抗體效價呈正相關(guān)。同時也與患兒血清間接膽紅素水平呈正相關(guān)；而ABO-HDN的發(fā)生與孕婦丈夫的血型無明顯關(guān)系。因此，為減少溶血程度，避免膽紅素腦病甚至死亡的發(fā)生，對于非首次妊娠及孕婦抗體效價較高1:64的孕婦臨床應(yīng)該連續(xù)監(jiān)測，密切關(guān)注。
[Abstract]:Objective: to analyze the effect of different pregnancy times on the occurrence of neonatal ABO hemolytic disease (ABOhemolytic disease of newborn, ABO-HDN) in type O blood pregnant women. The relationship between IgG antibody titer and (HDN) incidence and hemolytic degree of newborn hemolytic disease and the distribution of ABO-HDN blood group and occurrence of ABO-HDN were discussed. Methods: from November 2012 to January 2015, the patients admitted to Jilin Maternal and Child Health Hospital were collected to meet the selection criteria (excluding irregular antibodies of pregnant women tested positive, no blood transfusion records, normal liver and kidney function, There were 725 cases of pregnant women with O blood group (husband is non-O blood group), including 116 cases of ABO-HDN. Summary and analysis of the above cases: first, pregnant women were divided into first pregnancy group and non-first pregnancy group, 382 cases and 343 cases, respectively, to compare the influence of different pregnancy times on the occurrence of neonatal ABO hemolytic disease. Secondly, according to the ABO blood group of pregnant women, they were divided into two groups: husband O-A group, wife O-B group and wife O-AB group, including 284 cases in O-A group, 265 cases in O-B group and 176 cases in O-AB group. To explore the correlation between couple blood group incompatibility and ABO-HDN. Finally, the antibody titers of type O blood pregnant women were dynamically monitored, and the relationship between antibody titers and HDN was analyzed by measuring hemolysis test and indirect bilirubin concentration. Results in the first pregnancy group, the titer of hemolytic disease was less than 1:64 in 0 cases, 1: 128 in 8 cases (8 / 26), and 1: 256 in 9 cases (9 / 20). There were 2 cases (2 / 4) with titer of 1: 512 and 2 cases (2 / 3) with titer > 1: 512. In the non-first pregnancy group, the titer of hemolytic disease of newborn infants was less than 1:64 in 0 cases, 1: 128 in 32 cases (32 / 78), 1: 256 in 26 cases (26 / 46), and 1: 512 in 24 cases (24 / 28). There were 13 cases (13 / 13) with a titer of 1: 512; There were 284 cases of O-A blood group, 265 cases of O-B blood group and 176 cases of O-AB blood group. The incidence of ABO-HDN in O-A, O-B and O-AB was 30.6% (87 / 284), respectively. 28.3% (75 / 265) and 33.0% (58 / 176), the difference was not statistically significant (P0.05). There were 377 cases of maternal and infant ABO blood group incompatibility in different titers of IgG antibody against A (B) in 1:64 group, 130 cases in 1:64 group, 104 cases in 1: 128 group, 66 cases in 1: 256 group, 32 cases in 1: 512 group and 16 cases in 1: 512 group. And the positive rates of ABO-HDN were 0 (0 / 0), 0 (0 / 0), 38.5% (40 / 104), 53% (35 / 66), 81.3% (26 / 32), and 93.8% (15 / 16), respectively. The difference was statistically significant (P0.05). The antibody titer of pregnant women combined with the serum indirect bilirubin concentration after delivery showed that the serum indirect bilirubin level increased with the increase of maternal blood group antibody titer. Conclusion: the incidence of ABO-HDN in non-first-trimester pregnant women is higher than that in first-trimester pregnant women, and the incidence of ABO-HDN is positively correlated with the titer of antibodies in pregnant women. There was also a positive correlation between serum indirect bilirubin level and serum indirect bilirubin level, but there was no significant correlation between the occurrence of ABO-HDN and the blood group of husband. Therefore, in order to reduce the degree of hemolysis and avoid bilirubin encephalopathy or even death, clinical monitoring and close attention should be paid to the pregnant women whose antibody titers are higher than 1:64 in non-first-time pregnancy and pregnant women.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.6
本文編號：2406617
[Abstract]:Objective: to analyze the effect of different pregnancy times on the occurrence of neonatal ABO hemolytic disease (ABOhemolytic disease of newborn, ABO-HDN) in type O blood pregnant women. The relationship between IgG antibody titer and (HDN) incidence and hemolytic degree of newborn hemolytic disease and the distribution of ABO-HDN blood group and occurrence of ABO-HDN were discussed. Methods: from November 2012 to January 2015, the patients admitted to Jilin Maternal and Child Health Hospital were collected to meet the selection criteria (excluding irregular antibodies of pregnant women tested positive, no blood transfusion records, normal liver and kidney function, There were 725 cases of pregnant women with O blood group (husband is non-O blood group), including 116 cases of ABO-HDN. Summary and analysis of the above cases: first, pregnant women were divided into first pregnancy group and non-first pregnancy group, 382 cases and 343 cases, respectively, to compare the influence of different pregnancy times on the occurrence of neonatal ABO hemolytic disease. Secondly, according to the ABO blood group of pregnant women, they were divided into two groups: husband O-A group, wife O-B group and wife O-AB group, including 284 cases in O-A group, 265 cases in O-B group and 176 cases in O-AB group. To explore the correlation between couple blood group incompatibility and ABO-HDN. Finally, the antibody titers of type O blood pregnant women were dynamically monitored, and the relationship between antibody titers and HDN was analyzed by measuring hemolysis test and indirect bilirubin concentration. Results in the first pregnancy group, the titer of hemolytic disease was less than 1:64 in 0 cases, 1: 128 in 8 cases (8 / 26), and 1: 256 in 9 cases (9 / 20). There were 2 cases (2 / 4) with titer of 1: 512 and 2 cases (2 / 3) with titer > 1: 512. In the non-first pregnancy group, the titer of hemolytic disease of newborn infants was less than 1:64 in 0 cases, 1: 128 in 32 cases (32 / 78), 1: 256 in 26 cases (26 / 46), and 1: 512 in 24 cases (24 / 28). There were 13 cases (13 / 13) with a titer of 1: 512; There were 284 cases of O-A blood group, 265 cases of O-B blood group and 176 cases of O-AB blood group. The incidence of ABO-HDN in O-A, O-B and O-AB was 30.6% (87 / 284), respectively. 28.3% (75 / 265) and 33.0% (58 / 176), the difference was not statistically significant (P0.05). There were 377 cases of maternal and infant ABO blood group incompatibility in different titers of IgG antibody against A (B) in 1:64 group, 130 cases in 1:64 group, 104 cases in 1: 128 group, 66 cases in 1: 256 group, 32 cases in 1: 512 group and 16 cases in 1: 512 group. And the positive rates of ABO-HDN were 0 (0 / 0), 0 (0 / 0), 38.5% (40 / 104), 53% (35 / 66), 81.3% (26 / 32), and 93.8% (15 / 16), respectively. The difference was statistically significant (P0.05). The antibody titer of pregnant women combined with the serum indirect bilirubin concentration after delivery showed that the serum indirect bilirubin level increased with the increase of maternal blood group antibody titer. Conclusion: the incidence of ABO-HDN in non-first-trimester pregnant women is higher than that in first-trimester pregnant women, and the incidence of ABO-HDN is positively correlated with the titer of antibodies in pregnant women. There was also a positive correlation between serum indirect bilirubin level and serum indirect bilirubin level, but there was no significant correlation between the occurrence of ABO-HDN and the blood group of husband. Therefore, in order to reduce the degree of hemolysis and avoid bilirubin encephalopathy or even death, clinical monitoring and close attention should be paid to the pregnant women whose antibody titers are higher than 1:64 in non-first-time pregnancy and pregnant women.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R446.6
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