-
摘要: 目的 分析夫妇血型不合的O型血孕妇所生新生儿发生ABO新生儿溶血病(ABO-HDN)的影响因素。方法 收集2020年3月至2021年3月出生并送检ABO溶血病患儿1415例临床资料。其中410例为O型血孕妇所生非O型新生儿，血清学3项实验诊断是否发生HDN。采用χ2检验和二元logistic回归分析进行统计。结果 410例新生儿中诊断为ABO-HDN者230例(56.10%)，其中女婴确诊率63.70%(135/212)，明显高于男婴的48.00%(95/198)(P< 0.05)；确诊患儿中A型血占53.48%(123例)，明显高于B型的46.52%(107例)(P< 0.05)；送检日龄1~3 d的新生儿确诊率90.43%(208/230)，明显高于4~6 d的确诊率9.57%(22/230)(P< 0.05)；确诊新生儿中出生体重≥2500 g的婴儿占60.74%(212/349)，明显高于出生体重 < 2500 g婴儿的29.51%(18/61)(P< 0.01)；二元logistic回归分析表明，婴儿性别、血型、送检日龄和出生体重是影响ABO-HDN的独立因素。结论 O型血孕妇所生非O型新生儿发生ABO-HDN受婴儿性别、血型、送检日龄和出生体重的影响，在诊治过程中应该关注这些因素，有助于进行预防和诊断。Abstract: Objective To investigate the factors that affecting ABO hemolytic disease of the newborn(ABO-HDN) in neonates born to mothers with type O blood.Methods A total of 1415 cases who were born in our hospital from March 2020 to March 2021 were collected and submitted for ABO hemolytic disease testing. Among them, 410 cases of non-O newborns born to pregnant women with type O blood. All samples were subjected to three serological tests to confirm whether they suffered from hemolytic disease. Chi-square test and binary logistic regression analysis were used to take statistical analysis.Results Among 410 cases, 230(56.1%) were diagnosed as ABO-HDN, of which, the positive rate was higher in female infants(63.70%, 135/212) than that in male infants(48.00%, 95/198,P< 0.05). The positive rate of blood group A(53.48%) was higher than that of group B(46.52%,P< 0.05). The positive rate in testing time 1-3 days(90.43%) was higher than that in 4-6 days(9.57%,P< 0.05). The positive rate of infants with birth weight was 2500 g or greater accounted for(60.74%, 212/349), which was higher than that of the infants with birth weigh less than 2500 g(29.51%, 18/61,P< 0.01). Binary logistic regression analysis showed that gender, blood group, testing time and birth weight were independent factors influencing the diagnosis of ABO-HDN.Conclusion The occurrence of ABO-HDN in non-O neonates born to pregnant women with blood type O may be affected by the baby's gender, blood group, testing time and birth weight. These factors should be taken into consideration in the diagnosis and treatment process to help prevent and diagnosis.
-
Key words:
- ABO hemolytic disease of newborn /
- gender /
- blood type /
- birth weight
-
-
表 1 HDN血清学3项试验结果
例(%) 检测方法 阴性 阳性 游离抗体试验 0 410(100) 抗体释放试验 180(43.9) 230(56.1) 直接抗人球蛋白试验 397(96.8) 13(3.2) 
下载: 导出CSV
表 2 影响HDN发生的因素
例(%) 项目 总例数 阴性 阳性 χ2 P 性别 10.246 0.001 男 198 103(52.0) 95(48.0) 女 212 77(36.3) 135(63.7) 血型 9.302 0.002 A 192 69(35.9) 123(64.1) B 218 111(50.9) 107(49.1) DAT 10.507 0.001 阳性 13 0 13(100.0) 阴性 397 180(45.3) 217(54.7) 送检日龄 5.206 0.022 1~3 d 357 149(41.7) 208(58.3) 4~6 d 53 31(58.5) 22(41.5) 孕周 18.998 < 0.001 28~36周 81 53(65.4) 28(34.6) ≥37周 329 127(38.6) 202(61.4) 出生体重 20.572 < 0.001 < 2500 g 61 43(70.5) 18(29.5) ≥2500 g 349 137(39.3) 212(60.7)
下载: 导出CSV
表 4 ABO-HDN与送检日龄和性别
例(%) 送检日龄 男 女 χ2 P 阳性 阴性 阳性 阴性 1~3 d 87(50.6) 85(49.4) 121(65.4) 64(34.6) 8.055 0.005 4~6 d 8(30.8) 18(69.2) 14(51.9) 13(48.1) 2.425 0.119 合计 95(48.0) 103(52.0) 135(63.7) 77(36.3) 10.246 0.001
下载: 导出CSV
表 5 O-A型和O-B型2组间Hb、TB、DB和IDB
X ±S 血型组合 例数 Hb/(g·L-1) TB/(μmol·L-1) DB/(μmol·L-1) IDB/(μmol·L-1) O-A 123 172.6±19.3 185.5±61.7 10.2±1.7 175.3±61.5 O-B 107 170.6±21.7 185.3±60.4 10.1±1.6 175.2±60.0 t — 0.714 0.027 0.481 0.014 P — 0.476 0.979 0.631 0.989
下载: 导出CSV
表 6 logistic回归分析影响ABO-HDN确诊率的因素
变量 β 标准误 Wald P OR 95%CI 性别 -0.707 0.211 11.236 0.001 0.493 0.326~0.746 血型 0.702 0.212 10.935 0.001 2.018 1.331~3.060 送检日龄 0.712 0.309 5.294 0.021 2.038 1.111~3.738 出生体重 0.001 0.000 15.662 0.000 1.001 1.000~1.001
下载: 导出CSV
-
[1] Özgönenel B, Kukreja G, O'Malley B, et al. Neonatal BO Incompatibility Is Associated With a Positive Cord Blood Direct Antiglobulin Test in Infants of Black Ethnicity[J]. J Pediatr Hematol Oncol, 2015, 37(8): e453-e457. doi: 10.1097/MPH.0000000000000426
[2] Pan J, Zhan C, Yuan T, et al. Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study[J]. J Perinatol, 2021, 41(6): 1397-1402. doi: 10.1038/s41372-021-00963-5
[3] 姚润, 杨涓, 李宁. 不同血型系统胎儿或新生儿溶血病的特点[J]. 临床血液学杂志, 2021, 34(12): 890-893. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202112016.htm
[4] 杨勇, 任雪军, 朱樱梅. 新生儿溶血性高胆红素血症与胆红素脑病的关系研究[J]. 中国妇幼保健, 2019, 34(8): 1773-1774. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201908027.htm
[5] Li P, Pang LH, Liang HF, et al. Maternal IgG Anti-A and Anti-B Titer Levels Screening in Predicting ABO Hemolytic Disease of the Newborn: A Meta-Analysis[J]. Fetal Pediatr Pathol, 2015, 34(6): 341-350. doi: 10.3109/15513815.2015.1075632
[6] 杨蛟, 贺金峰, 努尔亚, 等. 新生儿溶血病与胆红素脑病的诊治分析[J]. 新疆医学, 2012, 42(7): 13-16. doi: 10.3969/j.issn.1001-5183.2012.07.003
[7] 黄玉开, 周珍文, 曾兰兰, 等. 1349例新生儿ABO溶血病的检测与分析[J]. 热带医学杂志, 2019, 19(6): 770-772, 780. doi: 10.3969/j.issn.1672-3619.2019.06.025
[8] 蔡大凤, 荣成智, 秦雪, 等. 新生儿溶血病患儿的实验结果及相关因素分析[J]. 检验医学与临床, 2020, 17(14): 2000-2003. doi: 10.3969/j.issn.1672-9455.2020.14.016
[9] 刘琼, 刘蜜. 诊断ABO新生儿溶血病的实验研究[J]. 湖南师范大学学报(医学版), 2016, 13(6): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYG201606006.htm
[10] 许飞, 曹锁春, 张建伟, 等. 常州地区1003例新生儿溶血病检查结果分析[J]. 临床血液学杂志, 2018, 31(2): 139-140, 144. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ201802018.htm
[11] Storry JR, Olsson ML. The ABO blood group system revisited: a review and update[J]. Immunohematology, 2009, 25(2): 48-59. doi: 10.21307/immunohematology-2019-231
[12] 陆华, 肖瑞卿, 隆晓秋. 成人及新生儿红细胞表面ABH血型抗原强度的比较[J]. 重庆医学, 2013, 42(32): 3904-3905. doi: 10.3969/j.issn.1671-8348.2013.32.021
[13] 冯剑美, 王金秀, 王瑛. 腹部按摩对早产儿黄疸及生长发育的影响[J]. 实用临床医药杂志, 2016, 20(14): 196-197. doi: 10.7619/jcmp.201614069
[14] Zhu XJ, WeiJK, Zhang CM. Evaluation of endothelial microparticles as a prognostic marker in hemolytic disease of the newborn in China[J]. J Int Med Res, 2019, 47(11): 5732-5739. doi: 10.1177/0300060519870947
[15] 杨旭, 杨讯, 许词, 等. 内皮微颗粒对新生儿ABO溶血病预后价值的研究[J]. 实验与检验医学, 2021, 39(2): 305-308. doi: 10.3969/j.issn.1674-1129.2021.02.015
[16] 雷慧芬, 樊凤艳, 肖军, 等. 国内医疗机构胎儿新生儿溶血病免疫血液学检测情况分析[J]. 临床输血与检验, 2021, 23(1): 33-38. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202101009.htm
-
图(1)
表(6)
计量
- 文章访问数: 804
- PDF下载数: 729
- 施引文献: 0