Clinical significance of Rh antigen phenotype detection and irregular antibody screening for pregnant women
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摘要: 目的 对孕产妇Rh血型抗原表型分布特征及不规则抗体检测结果进行分析，探讨其与新生儿溶血病(HDN)之间的关系。方法 选取2019年5月—2020年6月申请备血的孕产妇5550例为研究组，同期申请备血的男性患者3455例为对照组。采用微柱凝胶法对2组患者血样进行Rh抗原表型检测及不规则抗体筛查。收集孕妇分娩新生儿血液检测Rh抗原表型，记录Rh新生儿溶血病(Rh-HDN)发生情况。结果 9005例患者血样中检测出13种Rh血型表现型，以CCDee(45.39%)和CcDEe(34.31%)为主。研究组检测出30例(0.54%)Rh血型抗体阳性，对照组检测出1例(0.03%)Rh血型抗体阳性。孕产妇Rh系统抗体的检出率显著高于男性(P< 0.05)。引起Rh-HDN的抗体中，抗E抗体(60%)占比最大。结论 孕产夫妻的Rh抗原分型检测及孕妇不规则抗体筛查，可以为HDN的临床治疗提供依据及指导临床安全输血。Abstract: Objective To analyze the distribution characteristics of Rh antigen phenotype and detection results of irregular antibody in pregnant women, and explore its relationship with hemolytic disease of the newborn.Methods A total of 5550 pregnant women who applied for blood preparation in our hospital from May 2019 to June 2020 were selected as the research group, and 3455 male patients who applied for blood preparation during the same period were selected as the control group. Microcolumn gel method was used to detect Rh antigen phenotype and irregular antibody screening in blood samples of two groups. The blood of the newborns was collected to detect the Rh antigen phenotype, and the occurrences of Rh hemolytic disease of the newborns(Rh-HDN) were recorded.Results A total of 13 Rh blood group phenotypes were detected in the blood samples of 9005 patients, mainly CCDee(45.39%) and CcDEe(34.31%). 30 patients(0.54%) were positive for Rh blood group antibody in the research group, while 1 patient(0.03%) was positive for Rh blood group antibody in the control group. The detection rate of Rh system antibodies in pregnant women was significantly higher than that in men(P< 0.05). Anti-E antibodies(60%) accounted for the largest proportion among the antibodies that caused Rh-HDN.Conclusion The detection of Rh antigen typing in pregnant couples and the screening of irregular antibodies in pregnant women can provide the basis for clinical treatment of HDN and guide clinical safe blood transfusion.
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表 1 2组患者Rh抗原表型分布
例(%) Rh表型 研究组
(5550例)对照组
(3455例)合计
(9005例)CCDee 2501(45.06) 1587(45.93) 4088(45.40) CcDEe 1917(34.54) 1173(33.95) 3090(34.31) CcDee 466(8.40) 330(9.55) 796(8.84) ccDEE 368(6.63) 209(6.05) 577(6，41) ccDEe 176(3.17) 104(3.01) 280(3.11) CCDEe 36(0.65) 25(0.72) 61(0.68) CcDEE 14(0.25) 9(0.26) 23(0.26) ccDee 12(0.22) 11(0.32) 23(0.26) ccdee 30(0.54) 5(0.14) 35(0.39) Ccdee 25(0.45) 2(0.06) 27(0.30) CCdee 2(0.04) 0 2(0.04) CcdEe 2(0.04) 0 2(0.04) ccdEe 1(0.02) 0 1(0.02) 
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表 2 Rh-HND患儿及母亲的血清学结果
编号 新生儿血型 母亲血型 新生儿放散液抗体 母亲血清抗体 母亲抗体效价 1 O、ccDEe O、ccdee 抗D 抗D 1︰256 2 O、CcDee O、ccdee 抗D 抗D 1︰512 3 B、CcDee B、ccdee 抗D 抗D 1︰64 4 O、CcDEe O、CcDee 抗E 抗E 1︰32 5 A、CcDEe A、CCDee 抗E 抗E 1︰32 6 A、CcDEe A、CCDee 抗E 抗E 1︰32 7 B、CcDEe B、CCDee 抗E 抗E 1︰32 8 B、CcDEe B、CCDee 抗E 抗E 未测 9 B、CCDEe AB、CCDee 抗E 抗E 1︰16 (亚临床型) 10 B、CcDEe AB、CCDee 抗Ec 抗Ec 1︰128
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