Study on relationship between IgG antibody subtypes of Rh negative pregnant women and hemolytic disease of newborn
-
摘要: 目的 探讨产前稀有血型孕妇IgG抗体亚型与新生儿溶血病(hemolytic disease of the newborn，HDN)的相关性。方法 选择2020年5月至2022年5月接收的Rh(D)阴性孕妇81例，对所有孕妇临床资料进行回顾性分析。检测夫妇血型、孕妇不规则抗体、孕妇IgG抗体效价及其亚型含量、新生儿溶血相关试验，对产前稀有血型孕妇IgG抗体各亚型及新生儿溶血情况进行分析，并分析产前稀有血型孕妇IgG抗体亚型与HDN的相关性。结果 81例孕妇中Rh-HDN总发生率为56.79%，母亲血清IgG1、IgG2、IgG3、IgG4亚型抗体检测含量高于非HDN组(P < 0.05)。轻度黄疸组IgG1、IgG3亚型含量与中重度黄疸组比较，差异有统计学意义(P < 0.05)。经多因素分析，IgG1是影响HDN发生的独立危险因素(P < 0.05)。轻度黄疸组IgG1、IgG3亚型含量与中重度黄疸组比较，差异有统计学意义(P < 0.05)。81例孕妇血清抗D抗体效价≥64者58例，产后新生儿20例发生重度HDN，进行换血治疗，换血率达34.48%。结论 稀有血型孕妇产前需检测血型抗体IgG亚型，对高效价孕妇需行IgG亚型分析，若IgG1、IgG2 2种亚型明显上升则应及时给予积极干预治疗，以实现早期精准诊断及治疗。Abstract: Objective To investigate the correlation between IgG antibody subtypes of prenatal pregnant women with rare blood types and hemolytic disease of the newborn(HDN).Methods A total of 81 Rh(D) negative pregnant women admitted to our hospital from May 2020 to May 2022 were selected, and the clinical data of all pregnant women were retrospectively analyzed. The blood type of the couple, the irregular antibody of pregnant women, the titer and subtype content of IgG antibody in pregnant women and the related test of neonatal hemolysis were detected. Correlation between blood group IgG antibody subtypes in pregnant women and hemolytic disease of the newborn was analyzed.Results The total incidence of Rh-HDN in 81 pregnant women was 56.79%. The maternal serum IgG1, IgG2, IgG3 and IgG4 subtype antibody levels in Rh-HDN group were higher than those in non-HDN group(P < 0.05). The contents of IgG1 and IgG3 subtypes in the mild jaundice group were compared with those in the moderate and severe jaundice group(P < 0.05). After multivariate analysis, IgG1 was an independent risk factor for the occurrence of HDN(P < 0.05). The content of IgG1 and IgG3 subtypes in the mild jaundice group was significantly different from that in the moderate and severe jaundice group(P < 0.05). Of the 81 pregnant women, 58 had serum anti-D antibody titers ≥64, and 20 postpartum neonates developed severe HDN. Exchange transfusion was performed, and the exchange transfusion rate was 34.48%.Conclusion Pregnant women with rare blood types need to detect IgG subtype of blood group antibodies before delivery, and IgG subtype analysis is required for pregnant women with high titer. If the two subtypes of IgG1 and IgG2 are significantly increased, active intervention should be given in time to achieve early accurate diagnosis and treatment.
-
-
表 1 HDN组与非HDN组母亲血清IgG亚型检测结果比较
例 指标 组别 例数 检测结果 Z P - ± 1+ 2+ 3+ 4+ IgG1 Rh-HDN 46 0 4 15 17 6 4 7.032 ＜0.001 非HDN 35 26 5 2 2 0 0 IgG2 Rh-HDN 46 4 5 13 16 7 1 5.053 ＜0.001 非HDN 35 23 4 3 3 2 0 IgG3 Rh-HDN 46 2 7 11 15 7 4 6.738 ＜0.001 非HDN 35 27 4 3 1 0 0 IgG4 Rh-HDN 46 3 7 15 13 8 0 5.851 ＜0.001 非HDN 35 25 5 2 2 1 0 
下载: 导出CSV
表 2 HDN发生logistic多因素分析
项目 β SE Walds df P Exp(β) 95%CI IgG1 1.527 0.485 5.035 1 0.018 3.964 1.201~11.985 IgG2 -0.682 0.727 0.954 1 0.284 0.516 0.098~2.274 IgG3 1.136 0.803 1.179 1 0.198 2.143 0.846~9.657 IgG4 -0.337 0.516 0.503 1 0.529 0.703 0.307~1.846
下载: 导出CSV
表 3 HDN溶血严重程度与IgG亚型情况比较
例 指标 组别 例数 检测结果 Z P - ± 1+ 2+ 3+ 4+ IgG1 轻度黄疸 31 4 13 9 4 1 0 2.313 0.021 中重度黄疸 15 0 5 2 5 2 1 IgG2 轻度黄疸 31 8 13 2 5 2 1 2.064 0.039 中重度黄疸 15 0 3 9 3 0 0 IgG3 轻度黄疸 31 2 5 9 11 3 1 1.822 0.069 中重度黄疸 15 1 6 5 2 1 0 IgG4 轻度黄疸 31 6 11 10 4 0 0 0.212 0.835 中重度黄疸 15 2 7 3 2 1 0
下载: 导出CSV
表 4 IgG亚型与新生儿溶血试验结果比较
例 抗体效价 例数 3项试验阳性 亚型含量 换血 直抗 游离 释放 IgG1 IgG2 IgG3 IgG4 ≤32 23 4 11 4 2 10 5 7 0 64~256 50 23 21 23 23 16 14 9 12 ≥512 8 8 8 8 8 7 8 5 8
下载: 导出CSV
-
[1] Pegoraro V, Urbinati D, Visser GHA, et al. Hemolytic disease of the fetus and newborn due to Rh(D)incompatibility: A preventable disease that still produces significant morbidity and mortality in children[J]. PLoS One, 2020, 15(7): e0235807. doi: 10.1371/journal.pone.0235807
[2] 马印图, 王更银, 李烛, 等. 母婴血型不合新生儿溶血病IgG抗体亚型分析[J]. 临床输血与检验, 2020, 22(3): 269-272. doi: 10.3969/j.issn.1671-2587.2020.03.011
[3] Krog GR, Donneborg ML, Hansen BM, et al. Prediction of ABO hemolytic disease of the newborn using pre-and perinatal quantification of maternal anti-A/anti-B IgG titer[J]. Pediatr Res, 2021, 90(1): 74-81. http://www.nature.com/articles/s41390-020-01232-5
[4] Wang R, Li Y, Tong Y, et al. Hemolytic Disease of the Fetus and Newborn Caused by Anti-Group A IgG From a Group B Mother[J]. J Pediatr Hematol Oncol, 2021, 43(6): e785-e787. doi: 10.1097/MPH.0000000000001948
[5] 蒋璐茜, 杜垚强, 谢一唯, 等. 不同孕期ABO血型IgG抗体效价预测新生儿溶血病发生的效能比较[J]. 浙江医学, 2020, 42(22): 2417-2420. doi: 10.12056/j.issn.1006-2785.2020.42.22.2020-1192
[6] 宋建, 杨婷, 周小芳, 等. 新生儿体内IgG型血型抗体效价与新生儿溶血病严重程度的相关性分析[J]. 中国实验血液学杂志, 2022, 30(2): 547-551. https://www.cnki.com.cn/Article/CJFDTOTAL-XYSY202202038.htm
[7] 马筱洁, 王儒彬, 李强, 等. 147例Rh血型系统意外抗体致新生儿溶血病回顾性分析[J]. 临床血液学杂志, 2021, 34(2): 102-104. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXZ202102006.htm
[8] 庞新丰, 乔静, 范贞, 等. 新生儿溶血病与母体血型抗体IgG免疫球蛋白分型相关性分析[J]. 中国优生与遗传杂志, 2020, 28(12): 1489-1490. doi: 10.13404/j.cnki.cjbhh.2020.12.020
[9] Sarihi R, Ahmadnejad M, Mohammadi S, et al. Hemolytic disease of the fetus and newborn caused by anti-Hr0 in a 27-year-old female with Dc-phenotype: A case report[J]. Transfus Apher Sci, 2021, 60(1): 102913. doi: 10.1016/j.transci.2020.102913
[10] 肖军, 郑飞天, 陈柄澔, 等. O型孕产妇IgG抗体效价与胎儿新生儿溶血病关系的Meta分析[J]. 中国输血杂志, 2020, 33(9): 925-928. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO202009022.htm
[11] Das S, Shastry S, Chakravarthy PK, et al. Clinical Implication of Immunohaematological Tests in ABO haemolytic disease of newborn: Revisiting an old disease[J]. Transfus Med, 2021, 31(1): 30-35. http://pubmed.ncbi.nlm.nih.gov/32969542/
[12] Wienzek-Lischka S, Bachmann S, Froehner V, et al. Potential of Next-Generation Sequencing in Noninvasive Fetal Molecular Blood Group Genotyping[J]. Transfus Med Hemother, 2020, 47(1): 14-22. http://pubmed.ncbi.nlm.nih.gov/32110190/
[13] 钱明明, 郭霞, 乔芳, 等. 母婴ABO血型不合合并IgG抗-M抗体引起新生儿溶血病1例[J]. 安徽医药, 2021, 25(10): 2102-2105. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYY202110045.htm
[14] Rieneck K, Egeberg Hother C, Clausen FB, et al. Next Generation Sequencing-Based Fetal ABO Blood Group Prediction by Analysis of Cell-Free DNA from Maternal Plasma[J]. Transfus Med Hemother, 2020, 47(1): 45-53. http://pubmed.ncbi.nlm.nih.gov/32110193/
[15] Bakht A, Turner B, Warren CS, et al. Anti-S Antibody: A Rare Cause of Fetal Hydrops in a Previously Sensitized Mother[J]. Lab Med, 2021, 52(6): 609-613. http://pubmed.ncbi.nlm.nih.gov/33900405/
[16] 马印图, 陈莉, 张怡, 等. 两种检测血型抗体IgG亚型的方法比较[J]. 河北医学, 2020, 26(5): 775-778. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202005018.htm
[17] 符明昌, 周莲, 蔡添娥, 等. O型血孕妇血清IgG抗A(B)抗体效价预测新生儿溶血病价值[J]. 中国计划生育学杂志, 2022, 30(5): 1171-1173. https://www.cnki.com.cn/Article/CJFDTOTAL-JHSY202205044.htm
[18] 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
[19] Krog GR, Lorenzen H, Clausen FB, et al. ABO haemolytic disease of the newborn: Improved prediction by novel integration of causative and protective factors in newborn and mother[J]. Vox Sang, 2022, 117(3): 415-423. http://onlinelibrary.wiley.com/doi/10.1111/vox.13195/abstract
[20] 孟海华, 马全福, 陈生祥. 新生儿溶血病与孕妇血型、孕龄及IgG效价的关系及相关影响因素探讨[J]. 中国性科学, 2020, 29(8): 81-84. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ202008027.htm
-