切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

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:
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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
[1]
邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2013: 267-305.
[2]
中华医学会儿科学分会新生儿学组, 中国新生儿胆红素脑病研究协作组. 中国新生儿胆红素脑病的多中心流行病学调查研究[J]. 中华儿科杂志, 2012, 50(5): 331-335.
[3]
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation[J]. Pediatrics, 2004, 114(1): 297-316.
[4]
中华医学会儿科学分会新生儿学组, 《中华儿科杂志》编辑委员会. 新生儿高胆红素血症诊断和治疗专家共识[J]. 中华儿科杂志, 2014, 52(10): 745-748.
[5]
Covas MdelC,MedinaMS,VenturaS, et al. ABO hemolytic disease and developing of significant hyperbilirubinemia in term newborns: early predictive factors[J]. Arch Argent Pediatr, 2009, 107(1): 16-25.
[6]
UshaKK,SulochanaPV. Detection of high risk pregnancies with relation to ABO hemolytic disease of newborn[J]. Indian J Pediatr, 1998, 65(6): 863-865.
[7]
CorteyA,ElzaabiM,WaegemansT, et al. Efficacy and safety of intravenous immunoglobulins in the management of neonatal hyperbilirubinemia due to ABO incompatibility: a Meta-analysis[J]. Arch Pediatr, 2014, 21(9): 976-983.
[8]
SenterreT,MinonJM,RigoJ. Neonatal ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care[J]. Arch Pediatr, 2011, 18(3): 279-282.
[9]
RaimondiF,LamaS,LandolfoF, et al. Measuring transcutaneous bilirubin: a comparative analysis of three devices on a multiracial population[J]. BMC Pediatr, 2012, 12: 70.
[10]
石碧珍,陈兰,韩树萍, 等. 健康新生儿经皮小时胆红素百分位列线图预测高胆红素血症的价值[J]. 中国当代儿科杂志, 2016, 18(3): 201-205.
[11]
ValsamiS,PolitouM,BoutsikouT, et al. Importance of direct antiglobulin test (DAT) in cord blood: causes of DAT (＋) in a cohort study[J]. Pediatr Neonatol, 2015, 56(4): 256-260.
[12]
叶长钦,张弘,李文忠, 等. 脐血溶血3项试验在新生儿ABO溶血病早期诊断中的价值[J]. 中华实用诊断与治疗杂志, 2013, 27(1): 45-46.
[13]
李薇,陈自励. 新生儿ABO溶血病早期诊断和治疗的意义[J]. 中国新生儿科杂志, 2011, 26(6): 383-385.
[14]
GeaghanSM. Diagnostic laboratory technologies for the fetus and neonate with isoimmunization[J]. Semin Perinatol, 2011, 35(3): 148-154.
[15]
杨冬梅,李志坚. ABO新生儿溶血病引起高胆红素血症患儿溶血三项试验的相关性研究[J]. 中国药物与临床, 2017, 17(6): 911-913.
[16]
陶华. 产前检测抗体预防母儿ABO血型不合新生儿溶血病259例临床观察 [J]. 中国妇幼保健, 2011, 26(20): 3085-3087.
[17]
LainSJ,RobertsCL,BowenJR, et al. Early discharge of infants and risk of readmission for jaundice[J]. Pediatrics, 2015, 135(2): 314-321.
[18]
WatchkoJF. Hyperbilirubinemia in African American neonates: clinical issues and current challenges[J]. Semin Fetal Neonatal Med, 2010, 15(3): 176-182.
[19]
闫沁,陈剑,赵虹. 2种放散试验方法对于新生儿ABO溶血病检测的临床效果评价 [J]. 国际输血及血液学杂志, 2016, 39(6): 480-483.
[20]
韩雪芹,唐建军,夏斌. 足月新生儿ABO溶血病伴高胆红素血症的临床分析[J/CD]. 中华妇幼临床医学杂志(电子版), 2016, 12(2): 154-158.
[21]
胡江,方乐,陈青. O型血孕妇血清IgG抗A(B)血型抗体效价对新生儿溶血病发病的影响研究 [J]. 国际输血及血液学杂志, 2015, 38(6): 472-476.
[22]
AkgülS,KorkmazA,YigitS, et al. Neonatal hyperbilirubinemia due to ABO incompatibility: does blood group matter? [J]. Turk J Pediatr, 2013, 55(5): 506-509.
[23]
CorteyA,ElzaabiM,WaegemansT, et al. Efficacy and safety of intravenous immunoglobulins in the management of neonatal hyperbilirubinemia due to ABO incompatibility: a Meta-analysis [J]. Arch Pediatr, 2014, 21(9): 976-983.
[24]
BhatRY,KumarPC. Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates [J]. World J Pediatr, 2014, 10(2): 182-185.
[25]
DillonA,ChaudhariT,CrispinP, et al. Has anti-D prophylaxis increased the rate of positive direct antiglobulin test results and can the direct antiglobulin test predict need for phototherapy in Rh/ABO incompatibility? [J]. J Paediatr Child Health, 2011, 47(1-2): 40-43.
[26]
PeetersB,GeertsI,Van MullemM, et al. Post-test probability for neonatal hyperbilirubinemia based on umbilical cord blood bilirubin, direct antiglobulin test, and ABO compatibility results [J]. Eur J Pediatr, 2016, 175(5): 651-657.
[1] 谢燕华, 陈伟玲, 唐子鉴, 陶宏伟, 何学智, 黄兵旋, 许娜, 夏焙. 新生儿及小婴儿化脓性髋关节炎的超声诊断：病例系列研究[J]. 中华医学超声杂志（电子版）, 2022, 19(12): 1377-1382.
[2] 包艳娟, 杨小红, 杨星海, 潘圣宝, 杨帆, 赵胜. 腹膜后内寄生胎产前和新生儿期的临床与超声影像学特征[J]. 中华医学超声杂志（电子版）, 2022, 19(12): 1349-1354.
[3] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[4] 杨莹, 刘艳, 王央丹. 新生儿结节性硬化症相关性癫痫1例并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 464-472.
[5] 魏徐, 张鸽, 伍金林. 新生儿脓毒症相关性凝血病的监测和治疗[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 379-386.
[6] 赵金琦, 杨楠, 宫丽霏, 唐玥, 李璐璐, 杨海河, 孔元原. 2011—2020年北京市小于胎龄儿出生状况分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 278-286.
[7] 张霭润, 招嘉樑, 李管明, 李嘉鸿, 陈静蓉, 王兰, 庄思齐, 房晓祎. 早产儿RhE合并Rhc溶血病1例并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 93-99.
[8] 张雯, 徐宏燕, 张彦春, 刘凯波. 2017—2021年北京市先天性心脏病流行病学资料分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 61-68.
[9] 陈玉莲, 刘瀚旻. 人体生命早期呼吸系统菌群与肺部微生物组发育特征及早期菌群稳态研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 31-37.
[10] 郝萧, 刘兴莉, 夏小叶, 刁雪芹, 姚美雪. 母亲免疫球蛋白G不规则抗体效价及其效价积分对母婴Rh血型不合新生儿溶血病患儿换血治疗的预测分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 677-684.
[11] 李佳丽, 吴杨, 张莉, 夏斌, 何洋, 陈忠, 唐军, 母得志. 新生儿消化道穿孔患儿的临床特点及治疗结局[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 703-711.
[12] 李东明, 何升. 先天性巨细胞病毒感染早期筛查研究现状[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 627-633.
[13] 张非红, 夏斌. 肠道菌群失调与新生儿坏死性小肠结肠炎发病机制的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(05): 523-527.
[14] 赵超, 郑超, 周健. 永存胚胎血管的研究进展[J]. 中华眼科医学杂志(电子版), 2022, 12(06): 352-356.
[15] 强光峰, 孟兰兰, 赵静, 牛峰海, 任雪云. 肺部超声评分对呼吸困难新生儿使用有创机械通气的预测价值[J]. 中华诊断学电子杂志, 2023, 11(02): 104-108.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号