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中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (02) : 180 -185. doi: 10.3877/cma.j.issn.1673-5250.2018.02.009

所属专题： 文献；

论著

脐带血早期诊断新生儿ABO溶血病对预防严重高胆红素血症的价值
唐建军1, 刘莉2, 夏斌2,†()   
  1. 1. 611730　成都市郫都区人民医院儿科
    2. 610041　成都，四川大学华西第二医院儿科、出生缺陷与相关妇儿疾病教育部重点实验室
  • 收稿日期:2018-03-09 修回日期:2018-03-20 出版日期:2018-04-01
  • 通信作者: 夏斌

Values of early diagnosis of neonatal ABO hemolytic disease with cord blood to prevent severe hyperbilirubinemia

Jianjun Tang1, Li Liu2, Bin Xia2,†()   

  1. 1. Department of Pediatrics, Chengdu Pidu District People′s Hospital, Chengdu 611730, Sichuan Province, China
    2. Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2018-03-09 Revised:2018-03-20 Published:2018-04-01
  • Corresponding author: Bin Xia
  • About author:
    Corresponding author: Xia Bin, Email:
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引用本文：

唐建军, 刘莉, 夏斌. 脐带血早期诊断新生儿ABO溶血病对预防严重高胆红素血症的价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2018, 14(02): 180-185.

Jianjun Tang, Li Liu, Bin Xia. Values of early diagnosis of neonatal ABO hemolytic disease with cord blood to prevent severe hyperbilirubinemia[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(02): 180-185.

目的

探讨出生时采用脐带血直接抗人球蛋白试验(DAT)及抗体释放试验早期诊断新生儿ABO溶血病，对预防严重高胆红素血症的价值。

方法

选择2013年6月至2016年6月，于四川大学华西第二医院新生儿科确诊为ABO溶血病的655例晚期早产儿及足月新生儿为研究对象。其中，出生时经脐带血DAT及抗体释放试验确诊为ABO溶血病的188例患儿纳入研究组，入院后经静脉血DAT及抗体释放试验确诊为ABO溶血病的467例患儿纳入对照组。回顾性分析2组患儿的临床病例资料，并采用t检验或χ2检验，对2组患儿的一般临床资料、主要实验室检查结果、治疗及近期预后等，进行统计学比较。本研究与所有患儿监护人均签署知情同意书。

结果

①研究组患儿入院年龄及发现黄疸时年龄，均小于对照组[(34.3±21.8) h vs (58.8±34.3) h，(22.0±12.8) h vs (32.3±19.0) h]，入院时血清总胆红素(TSB)浓度及血红蛋白(Hb)水平，均低于对照组[(185.5±49.2) μmol/L vs (243.3±85.1) μmol/L，(147.3±21.6) g/L vs (153.8±24.9) g/L]，剖宫产比例高于对照组(70.2% vs 56.5%)，并且上述临床指标比较，差异均有统计学意义(t＝9.071，P<0.001；t＝6.831，P<0.001；t＝8.743，P<0.001；t＝3.132，P＝0.002；χ2＝10.492，P＝0.001)。②研究组患儿换血率及白蛋白使用率均低于对照组(0 vs 9.0%，9.6% vs 22.5%)，并且差异均有统计学意义(χ2＝18.532，P<0.001；χ2＝15.151，P<0.001)。③7例发生胆红素脑病患儿，均为对照组患儿。

结论

出生时采用脐带血DAT及抗体释放试验筛查ABO溶血病，可使医师和监护人对ABO溶血病患儿的黄疸加强监测，有助于早期发现需要住院光疗的患儿，避免发生需要采取换血治疗的严重高胆红素血症和胆红素脑病。

关键词: ABO血型系统, 血型不合, 胎血, 高胆红素血症, 核黄疸, 婴儿，新生
Objective

To explore the values of prevention of severe hyperbilirubinemia through early diagnosis of neonatal ABO hemolytic disease by cord blood direct antiglobulin test (DAT) and antibody release test.

Methods

A total of 655 late preterm and full term infants were chosen as study subjects. They were diagnosed as ABO hemolytic disease from June 2013 to June 2016 in Department of Neonatology in West China Second University Hospital, Sichuan University. A total of 188 cases of ABO hemolytic disease neonates who were diagnosed with cord blood DAT and antibody release test at birth were assigned into observation group, and 467 ABO hemolytic disease neonates who were diagnosed with venous blood DAT and antibody release test after admitted to hospital were assigned into control group. Case informations of two groups were retrospectively analyzed. The general clinical data, main indexes of laboratory examination results, treatments, and short term prognosis were statistically compared between two groups by t test or chi-square test. All guardians of research subjects signed the informed consents.

Results

①The age of admission to hospital and discovery of jaundice in observation group were all younger than those in control group [(34.3±21.8) h vs (58.8±34.3) h, (22.0±12.8) h vs (32.3±19.0) h, respectively], the levels of total serum bilirubin (TSB) and hemoglobin (Hb) in observation group were lower than those in control group [(185.5±49.2) μmol/L vs (243.3±85.1) μmol/L, (147.3±21.6) g/L vs (153.8±24.9) g/L, respectively], proportion of cesarean section in observation group was higher than that in control group (70.2% vs 56.5%), and all the differences above were statistically significant (t=9.071, P<0.001; t=6.831, P<0.001; t=8.743, P<0.001; t=3.132, P=0.002; χ2=10.492, P=0.001). ②The blood exchange transfusion rates and albumin usage rates in observation group were all lower than those in control group (0 vs 9.0%, 9.6% vs 22.5%, respectively), and the differences were statistically significant (χ2=18.532, P<0.001; χ2=15.151, P<0.001). ③A total of 7 neonates with bilirubin encephalopathy were all in control group.

Conclusions

Screening ABO hemolytic disease by cord blood DAT and antibody release test at birth can strengthen physicians and guardians′ awareness of jaundice monitoring of neonatal ABO hemolytic disease, and to find out the infants who need phototherapy, to avoid severe hyperbilirubinemia and bilirubin encephalopathy which need blood exchange transfusion therapy.

Key words: ABO blood-group system, Blood group incompatibility, Fetal blood, Hyperbilirubinemia, Kernicterus, Infant, newborn
表1 2组患儿一般临床资料及主要实验室检查结果比较
组别 例数 入院年龄(h，±s) 胎龄(周，±s) 出生体重(g，±s) 性别[例数(%)] 分娩方式[例数(%)]
男 女 剖宫产 顺产
研究组 188 34.3±21.8 39.0±1.3 3 359±450 89(47.3) 99(52.7) 132(70.2) 56(29.8)
对照组 467 58.8±34.3 38.9±1.4 3 325±447 214(45.8) 253(54.2) 264(56.5) 203(43.5)
检验值 ? t＝9.071 t＝0.752 t＝1.412 χ2＝0.121 χ2＝10.492
P值 ? <0.001 0.453 0.122 0.734 0.001
组别 例数 胎次[例数(%)] 喂养方式[例数(%)] 发现黄疸时年龄(h，±s)a 入院时TSB浓度(μmol/L，±s)
1次 2次 ≥3次 母乳喂养 混合喂养
研究组 188 82(43.7) 36(19.1) 70(37.2) 65(34.6) 123(65.4) 22.0±12.8 185.5±49.2
对照组 467 202(43.2) 133(28.5) 132(28.3) 150(32.1) 317(67.9) 32.3±19.0 243.3±85.1
检验值 ? χ2＝22.462 χ2＝0.363 t＝6.831 t＝8.743
P值 ? 0.323 0.551 <0.001 <0.001
组别 例数 入院时Hb水平(g/L，±s) 入院时贫血[例数(%)] 血型[例数(%)] DAT阳性[例数(%)] 抗体释放试验阳性[例数(%)] 游离抗体试验阳性[例数(%)]
A型 B型
研究组 188 147.3±21.6 84(44.7) 96(51.1) 92(48.9) 42(22.3) 182(96.8) 183(97.3)
对照组 467 153.8±24.9 171(36.6) 268(57.4) 199(42.6) 116(24.8) 441(94.4) 443(94.9)
检验值 ? t＝3.132 χ2＝3.672 χ2＝4.463 χ2＝0.464 χ2＝1.632 χ2＝1.953
P值 ? 0.002 0.063 0.112 0.486 0.204 0.158
表2 2组患儿治疗、近期预后及胆红素脑病发生率比较
组别 例数 光疗时间(h，±s) 换血[例数(%)] 输血[例数(%)] 输注白蛋白[例数(%)] 静脉输注IVIG[例数(%)]
研究组 188 103.2±39.8 0(0) 22(11.6) 18(9.6) 64(34.0)
对照组 467 98.2±40.5 42(9.0) 43(9.2) 105(22.5) 124(26.6)
检验值 ? t＝1.431 χ2＝18.532 χ2＝0.931 χ2＝15.151 χ2＝3.675
P值 ? 0.151 <0.001 0.332 <0.001 0.055
组别 例数 住院时间(d，±s) 出院时TSB浓度(μmol/L，±s) 出院时Hb水平(g/L，±s) 出院4 d内因黄疸再入院[例数(%)] 胆红素脑病[例数(%)]
研究组 188 4.8±1.7 135.2±37.8 153.4±21.3 11(5.9) 0(0)
对照组 467 4.5±1.8 134.9±37.5 155.1±22.8 23(4.9) 7(1.5)
检验值 ? t＝1.461 t＝0.892 t＝0.823 χ2＝0.231 χ2＝1.607
P值 ? 0.151 0.942 0.412 0.631 0.205
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