探讨抗RhE合并抗Rhc抗体导致新生儿溶血病(HDN)的临床特点。

选择2019年12月，于中山大学附属第七医院住院治疗的1例RhE合并Rhc溶血病早产儿为研究对象。回顾性分析其临床病例资料。检索国内外数据库中抗RhE合并抗Rhc抗体所致HDN的相关文献，分析该病患儿的临床特点、治疗方案及预后。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。监护人对本例患儿的诊治均知情同意。

①本例患儿临床资料：女性，G₅P₃，出生胎龄为31⁺²周。因"未足月胎膜早破19 d，频发胎心减速"剖宫产术娩出，生后14 h出现发热、反应差、黄疸、贫血，血培养结果显示大肠埃希菌(ESBL+)，血清总胆红素(TBil)增高达换血阈值。患儿血型为O型Rh(CcDEe)、直接抗人球蛋白试验(DAT)阳性，其母血型为O型Rh(CCDee)。对本例患儿采取换血、输血、强光疗、静脉注射免疫球蛋白(IVIG)及抗感染等治疗，于生后37 d治愈出院。其主要出院诊断为Rh血型不合HDN(RhE合并Rhc)，新生儿败血症(宫内感染)等。门诊随访至生后24个月龄，患儿智力、运动发育正常。②文献检索结果：按照本研究检索策略，符合本研究纳入标准的文献共计14篇，涉及14例RhE合并Rhc HDN患儿，出生即存在贫血、黄疸，黄疸进展快，DAT阳性，及时予光疗、换血等治疗后，黄疸消退。对部分患儿的随访结果显示，未发现神经系统后遗症。

对于母亲检出血清不规则抗体，新生儿出现贫血、黄疸，并且出现时间早、进展快，需对患儿进行稀有血型不合溶血病筛查。对RhE合并Rhc HDN患儿，若采取早期积极治疗措施，患儿预后良好。

To investigate the clinical characteristics of hemolytic disease of newborn (HDN) caused by anti-RhE and anti-Rhc alloantibodies.

A premature infant with HDN caused by anti-RhE and anti-Rhc alloantibodies treated in the Seventh Affiliated Hospital, Sun Yat-sen University in December 2019 was chosen in study. The clinical data were retrospectively analyzed. Retrieved literature of study on clinical characteristics, treatment and prognosis of HDN children caused by anti-RhE and anti-Rhc alloantibodies were summarized based on domestic and foreign databases. This study followed the World Medical Association Declaration of Helsinki revised in 2013. The informed consents of the infant′s diagnosis and treatment were obtained from guardians.

① Clinical data of this case: A female infant, G₅P₃, whose gestational age was 31^{+ 2} weeks, was born by cesarean section due to " premature rupture of membranes for 19 days and frequent deceleration of fetal heart rate" . After admission, the baby had fever, poor response, and developed jaundice and anemia at 14 h after birth. The blood culture result showed Escherichia coli (ESBL+ ), and the serum level of total bilirubin (TBil) was higher than exchange transfusion threshold. The baby′s blood group was O blood type Rh (CcDEe) and her direct antiglobulin test (DAT) was positive. Her mother′s blood group was O blood type Rh (CCDee). After treated by exchange transfusion, blood transfusion, intensive phototherapy, immunoglobulin intravenous infusion, antibacteria and other supportive treatments, the infant was cured and discharged at 37 d after birth. The main discharge diagnoses were HDN due to Rh blood group incompatibility (anti-RhE and anti-Rhc alloantibodies), neonatal sepsis (intrauterine infection), etc.. She was followed up to the age of 24 months and had no psychomotor developmental retardation. ② Literature retrieval results: a total of 14 pieces of related literature that meet the retrieval strategy, which involving 14 cases of HDN caused by anti-RhE and anti-Rhc alloantibodies. Their main clinical manifestations were early-onset and progressive jaundice and anemia, DAT positive. By timely phototherapy, exchange transfusion and other treatments, their jaundice resolved gradually, and no indicated neurodevelopmental disability according to some case reports.

Rare blood group incompatibility hemolytic disease should be screened if mother has serum irregular antibodies and infant develops anemia and jaundice at early life and progresses rapidly. Infants with HDN caused by anti-RhE and anti-Rhc alloantibodies have good prognosis if treated actively in the early stage.