Analysis of hemolysis tests results of 141 cases with maternal and infant blood group incompatibility
-
摘要: 目的 探讨分析母婴血型不合患儿新生儿溶血病(hemolytic disease of newborn，HDN)检测结果及其与患儿间接胆红素(indirect bilirubin，IBIL)之间的关系。方法 选取2020年1月至2021年1月云南省第三人民医院收治的其母亲血型为O型RhD阳性的新生儿血液标本行血型鉴定，并用微柱凝胶试验技术做直接抗人球蛋白试验(direct anti human globulin test，DAT)、红细胞抗体放散试验(放散试验)、血清游离抗体试验(游离试验)，根据试验结果判定患儿是否发生ABO溶血，并监测患儿IBIL变化。结果 选取的141例标本中，HDN检测结果阳性101例，可疑阳性2例，阴性38例，HDN阳性患儿IBIL明显高于阴性患儿，差异有统计学意义(P < 0.05)。A型患儿77例，HDN阳性62例，阳性率80.52%；B型患儿62例，HDN阳性39例，阳性率62.90%。A型患儿HDN阳性率明显高于B型患儿，差异有统计学意义(P < 0.05)。日龄＜1 d患儿33例，阳性率51.52%；日龄1~3 d患儿78例，阳性率88.46%；日龄4~6 d患儿16例，阳性率68.75%；日龄≥7 d患儿14例，阳性率28.57%；可见行HDN检测时间越晚的患儿，IBIL越高，而患儿1~3 d时HDN阳性检测率最高，差异有统计学意义(P < 0.05)。在HDN阳性患儿中有93例进行了静脉注射丙种球蛋白治疗，比较丙种球蛋白治疗前后的IBIL，发现治疗后患儿IBIL(120.988±31.104)μmol/L明显较治疗前(190.055±63.687)μmol/L低，差异有统计学意义(P < 0.05)。结论 A型患儿比B型患儿更易发生新生儿ABO溶血病。采血时间越早HDN检出率越高，采血时间越晚患儿IBIL越高，应尽早行HDN检测，并及时进行丙种球蛋白治疗。Abstract: Objective To explore and analyze the results of neonatal hemolytic disease(HDN) and its relationship with the blood indirect bilirubin(IBIL) in children with maternal and infant blood group incompatibility.Methods Blood samples of newborns with O-RHD positive mothers admitted to the Third People's Hospital of Yunnan Province from January 2020 to January 2021 were selected for blood group identification. Direct anti-human globulin test(DAT), erythrocyte antibody release test(release test) and serum free antibody test(free test) were performed by microcolumn gel test. ABO hemolysis was determined according to the test results, and the changes in blood IBIL were monitored.Results Among the 141 samples, 101 were positive, 2 were suspicious positive, and 38 were negative. The blood IBIL value of the children with positive HDN was significantly higher than that of the children with negative HDN, with statistical significance(P < 0.05). A total of 77 patients with type A had HDN positive in 62 cases, with a positive rate of 80.52 %. A total of 62 patients with type B had HDN positive in 39 cases, with a positive rate of 62.90%. The positive rate of HDN in type A children was significantly higher than that in type B children, and the difference was statistically significant(P < 0.05). 33 cases were less than 1 day old, with a positive rate of 51.52%. 78 cases were 1-3 days old, with a positive rate of 88.46%. 16 cases were 4-6 days old, with a positive rate of 68.75%. 14 cases were older than 7 days, with a positive rate of 28.57%. It could be seen that the later the time of HDN detection, the higher the blood IBIL value, and the HDN positive detection rate was the highest in children 1 to 3 days, the difference was statistically significant(P < 0.05). Among the children with HDN positive, 93 patients received intravenous injection of gamma globulin. By comparing the blood IBIL before and after treatment, it was found that the blood IBIL of the children after treatment(120.988±31.104)μmol/L was significantly lower than that before treatment(190.055±63.687)μmol/L. The difference was statistically significant(P < 0.05).Conclusion Neonatal ABO hemolysis may be more likely in children with type A than in children with type B. The earlier the blood collection time, the higher the detection rate of HDN and the later the blood collection time, the higher the blood IBIL of the children. Therefore, HDN detection should be carried out as soon as possible and the proglobulin treatment should be carried out in time.
-
-
表 1 141例患儿HDN检测结果情况
组别 DAT 游离试验 放散试验 例数 占比/% 1组 阴 阴 阴 38 26.95 2组 阴 阴 阳 10 7.09 3组 阴 阳 阳 62 43.97 4组 阳 阳 阳 28 19.86 5组 阳 阴 阳 1 0.71 6组 阴 阳 阴 2 1.42 
下载: 导出CSV
表 3 患儿日龄与HDN检测阳性率、IBIL的关系
例 患儿日龄 例数 IBIL/(μmol/L) 阳性 阴性 可疑阳性 合计 阳性率/% < 1 d 33 77.994±61.160 17 16 0 33 51.52 1~3 d 78 199.491±49.713 69 8 1 78 88.46 4~6 d 16 229.469±37.523 11 5 0 16 68.75 ≥7 d 14 242.086±72.900 4 9 1 14 28.57
下载: 导出CSV
表 4 患儿IBIL与HDN检测结果的关系
HDN检测结果 例数 IBIL/(μmol/L) 阴性 38 146.445±104.839 阳性 101 189.910±61.966
下载: 导出CSV
-
[1] 董青青, 叶光勇. 新生儿ABO溶血病患儿血型及多因素分析[J]. 临床血液学杂志, 2022, 35(6): 410-413, 418. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202206005.htm
[2] 中国输血协会免疫血液学专业委员会. 胎儿新生儿溶血病实验室检测专家共识[J]. 临床输血与检验, 2021, 23(1): 20-23, 28. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202101006.htm
[3] 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
[4] 叶应妩, 王毓三, 申子瑜. 全国临床检验操作规程[M]. 4版. 南京: 东南大学出版社, 2006: 256-258.
[5] 杨琳, 安宁, 杨世明, 等. 225例住院患者血型血清学检测及其临床意义分析[J]. 细胞与分子免疫学杂志, 2022, 38(8): 743-747. https://www.cnki.com.cn/Article/CJFDTOTAL-XBFM202208011.htm
[6] 张钰, 张璐, 许纪玲, 等. 1300例新生儿溶血病血型血清学检测结果分析[J]. 中国输血杂志, 2020, 33(9): 922-924. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202009021.htm
[7] 高翠, 王利春. 影响新生儿并发高胆红素血症的危险因素分析[J]. 现代医学与健康研究电子杂志, 2022, 6(11): 124-127. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJD202211038.htm
[8] 黄家虎, 孙建华, 贝斐, 等. 新生儿高胆红素血症风险预测的区域性研究[J]. 中华新生儿科杂志, 2021, 36(5): 30-34.
[9] 李敏, 梁静玲, 王春花, 等. 新生儿经皮胆红素监测与分析[J]. 云南医药, 2022, 43(4): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-YNYY202204004.htm
[10] 高貂艳, 王雪芹. 静脉输注免疫丙种球蛋白治疗新生儿溶血病的疗效观察[J]. 血栓与止血学, 2022, 28(3): 937-938, 943. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX202203263.htm
[11] 张瑞英, 刘友红. 免疫丙种球蛋白治疗新生儿溶血病的疗效及对血清TBIL、Hb的影响[J]. 医学理论与实践, 2022, 35(4): 649-650. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202204045.htm
[12] 钱姣, 高秦盈, 程淑凤, 等. 微柱凝胶技术在ABO新生儿溶血病患儿输血前检验中的应用价值[J]. 临床医学研究与实践, 2020, 5(34): 130-131, 134. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS202034047.htm
[13] 何柏霖. 2208例疑似新生儿溶血病血清学检测结果分析[J]. 国际检验医学杂志, 2020, 41(2): 217-220. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202002022.htm
[14] 陈卓瑶, 邓秋连, 黄映红, 等. 两种放散试验联合检测对新生儿ABO溶血病诊断的意义[J]. 检验医学与临床, 2019, 16(18): 2660-2662. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL201918021.htm
[15] 曾彧. 新生儿溶血病患儿血型分布及血清学检测结果分析[J]. 临床合理用药杂志, 2019, 12(6): 31-32, 34. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY201906014.htm
[16] 刘月齐, 陈玉婷, 谢务杰, 等. 溶血三项实验诊断新生儿ABO溶血病的价值[J]. 中外医学研究, 2021, 19(20): 93-95. https://www.cnki.com.cn/Article/CJFDTOTAL-YJZY202120034.htm
[17] 徐文莹, 任新雯, 井忠翠, 等. ABO新生儿溶血病患儿溶血三项试验和就诊日龄与血清总胆红素水平的关系研究[J]. 临床输血与检验, 2021, 23(3): 306-309. https://www.cnki.com.cn/Article/CJFDTOTAL-LSXY202103004.htm
-