Detection and distribution of irregular antibodies to hemolytic disease in newborns
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摘要: 目的 分析不规则抗体所致新生儿溶血病(hemolytic disease of newborn，HDN)的抗体检测意义及其分布特点，为临床HDN的明确诊断和治疗措施提供依据。方法 选取102例在医院检测并证实为非ABO-HDN病例，收集患儿致病抗原体、日龄、是否输血、是否合并ABO-HDN以及母亲妊娠史、输血史等资料，分析其分布特点。结果 102例患儿中，Rh系统85例(83.33%)，MNS系统14例(13.73%)，Kidd系统3例(2.94%)。母亲有妊娠史78例(76.47%)；有输血史15例(14.71%)；男58例(56.86%)，女44例(43.14%)；合并ABO-HDN 14例(13.73%)，未合并88例(86.27%)。非ABO-HDN患儿不规则抗体常见于Rh系统的抗-D抗体，占比47.06%，其次为抗-E抗体，占比17.65%，以Kidd系统最少，占比2.94%；37℃反应性：1+~4+；免疫球蛋白(Ig)类型：IgG类93例，IgG+IgM类3例，IgM类6例。分析患儿各类指征与输血的相关性显示，患儿合并ABO-HDN与输血有关(P＜0.05)，与母亲妊娠史、患儿性别、抗体特异无关(P>0.05)。结论 不规则抗体所致HDN患儿多见于Rh系统的抗-D和抗-E抗体，37℃反应性：1+~4+，Ig类型主要为IgG类，合并ABO-HDN患儿与输血有关，应及时进行HDN抗体检测，根据检测结果及时临床干预，以降低HDN的病死率。Abstract: Objective To Analyze the significance and distribution characteristics of antibody detection in neonatal hemolytic disease(HDN) caused by irregular antibodies, providing a basis for the clear diagnosis and treatment of clinical HDN.Methods 102 cases of non ABO-HDN detected and confirmed in the hospital were selected, and data on the pathogenic antigen, age, whether blood transfusion was performed, whether combined with ABO-HDN, as well as maternal pregnancy and blood transfusion history were collected to analyze their distribution characteristics.Results Among the 102 children, there were 85 cases(83.33%) with Rh system, 14 cases(13.73%) with MNS system, and 3 cases(2.94%) with Kidd system. 78 cases(76.47%) had a mother's history of pregnancy; 15 cases(14.71%) had a history of blood transfusion; 58 males(56.86%) and 44 females(43.14%); 14 cases(13.73%) were combined with ABO-HDN, and 88 cases(86.27%) were not combined. Irregular antibodies in non ABO-HDN children were commonly found in the Rh system's anti D antibodies, accounting for 47.06%, followed by anti E antibodies, accounting for 17.65%, with the Kidd system being the least common, accounting for 2.94%; 37 ℃ reactivity: 1+ to 4+; Immunoglobulin(Ig) types: 93 cases of IgG, 3 cases of IgG+IgM, and 6 cases of IgM. Analysis of the correlation between various indications and blood transfusion in children showed that the presence of ABO-HDN was associated with blood transfusion(P<0.05), while maternal pregnancy history, child gender, and antibody specificity were not associated with it(P>0.05).Conclusion Irregular antibodies causing HDN in children were commonly seen in the Rh system with anti D and anti E antibodies. The reactivity at 37 ℃ was 1+ to 4+, and the Ig type was mainly IgG. Patients with ABO-HDN should undergo timely detection of neonatal HDN antibodies and clinical intervention based on the test results to reduce the mortality rate of HDN.
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表 1 非ABO-HDN患儿抗体特异性分布情况
系统类别 例数 百分比/% 特异性 37℃反应 Ig类型 Kidd系统 1 0.98 抗-JKa 1+~2+ IgG 2 1.96 抗-JKb 1+~2+ IgG MNS系统 6 5.88 抗-M 1+~2+ IgM 3 2.94 抗-M 2+~3+ IgG+IgM 1 0.98 抗-M 1+~2+ IgG 4 3.92 抗-S 1+~2+ IgG Rh系统 2 1.96 抗-Ce 1+~2+ IgG 1 0.98 抗-C 1+~2+ IgG 2 1.96 抗-e 1+~2+ IgG 5 4.90 抗-c 1+~2+ IgG 9 8.82 抗-Ec 2+~3+ IgG 18 17.65 抗-E 2+~3+ IgG 48 47.06 抗-D 2+~4+ IgG 合计 102 100.00 
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表 2 各类指征与患儿输血的相关性
例(%) 指征 例数 输血 未输血 χ2 P 母亲妊娠史 有 78 40(51.28) 38(48.72) 2.373 >0.05 无 24 8(33.33) 16(66.67) 患儿性别 男 58 28(48.28) 30(51.72) 0.080 >0.05 女 44 20(45.45) 24(54.55) 抗体特异性 Rh系统 85 41(48.24) 44(51.76) 0.283 >0.05 其他类型 17 7(41.18) 10(58.82) 合并ABO-HDN 是 14 12(85.71) 2(14.29) 9.733 ＜0.05 否 88 36(40.91) 52(59.09)
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