摘要
目的探讨脐带血血清总胆红素检测在新生儿ABO溶血病(ABO-HDN)早期诊治中的意义,为早期筛查诊治新生儿溶血病提供参考。方法选择2013年3月-2016年2月浙江省台州医院482例母婴ABO血型不合新生儿为研究对象,进行ABO溶血三项试验,全自动生化分析仪测定脐带血血清总胆红素水平,分析脐带血血清总胆红素与HDN溶血三项不同试验结果、母亲血型、黄疸出现时间的相关性。结果 482例新生儿中ABO-HDN发生率为31.95%,其中母婴O-O型、O-A型、O-B型各占22.08%、46.75%、31.17%;77例发生高胆红素血症,HDN发生率、脐带血胆红素水平、抗体释放试验与游离抗体试验阳性率母婴O-A/B血型明显高于母婴O-O血型组(P<0.05),HDN发生率、脐带血胆红素水平在母婴O-A血型及母婴O-B血型间比较差异无统计学意义(P>0.05),抗体释放试验与游离抗体试验阳性率母婴O-A血型明显高于母婴O-B血型组(分别χ~2=5.265,P=0.021;χ~2=9.075,P=0.000),脐带血总胆红素在日龄≤3 d组明显高于日龄>3 d组,脐带血总胆红素水平DAT阳性患者明显高于DAT阴性患者(P<0.05),脐带血总胆红素水平在DAT阳性患者之间、DAT阴性患者之间比较差异无统计学意义(P>0.05),游离试验阳性与阴性之间比较差异无统计学意义;脐带血总胆红素水平越高,高胆红素血症发生率越高(r=0.741,P<0.05)。结论对于ABO血型不合新生儿脐带血血清总胆红素检测及溶血三项试验在早期诊治ABO-HDN方面有重要意义。
Objective To explore the value of detecting serum total bilirubin in umbilical cord blood in the early diagnosis and treatment of hemolytic disease of newborns （ HDN ） so as to provide references for its early screening, diagnosis and therapy. Methods A total of 482 neonates with maternal-fetal ABO incompatibility were selected as the research objects in Taizhou Hospital of Zhejiang Province from March, 2013 to February, 2016. Serological hemolysis three tests （direct antiglobulin test （DAT）, antibody release test （ART） and free antibody test （ FAT） ） were performed, and the serum total bilirubin level was detected by automatic biochemical analyzer. We analyzed the correlation between the serum total bilirubin level and the results of the three different hemolysis tests, mother＇ s blood type, time of occurrence of jaundice. Results The incidence rate of ABO-HDN in the 482 neonates was 31.95%, of which the maternal and neonatal types of O-O, O-A and O-B accounted for 22.08%, 46.75% and 31.17% respectively. 77 neonates suffered from hyperbilirubinemia. The incidence rate of HDN, bilirubin level in umbilical cord blood, positive rates of antibody release test and free antibody test in the maternal and neonatal O-A/B blood group were significantly higher than those in the maternal and neonatal O-O blood group （ all P〈0.05 ）. No statistically significant differences were found in the incidence rate of HDN and bilirubin level in umbilical cord blood between the maternal and neonatal O-A blood group and the maternal and neonatal O-B blood group （ both P〉0.05 ）. The positive rates of antibody release test and free antibody test in the maternal and neonatal O-A blood group were both significantly higher than those of the maternal and neonatal O-B blood group （χ^2 = 5.265, P = 0. 021 ; χ^2= 9. 075, P= 0.000）. The total bilirubin in umbilical cord blood was significantly higher in the age group of ≤ 3 days than in the age group of 〉 3 days. The serum total bilirubin level was significantly higher in DAT-positive patients than in DAT- negative patients （P〈0.05）. No statistically significant difference was found in the serum total bilirubin level among DAT-positive patients as well as among DAT-negative patients （both P〉0.05）. There was no statistically significant difference betweem FAT- positive patients and FAT-negative patients. The higher the level of bilirubin in umbilical cord blood, the higher the incidence of hyperbilirubinemia （r=0.741, P〈0.05）. Conclusions Serum total bilirubin detection in umbilical cord blood and serological hemolysis three tests in newborns with ABO incompatibility play important roles in the early diagnosis and treatment of ABO-HDN.
出处
《实用预防医学》
CAS
2017年第4期491-494,共4页
Practical Preventive Medicine
关键词
脐带血
血清总胆红素
新生儿ABO溶血病
溶血三项试验
umbilical cord blood
serum total bilirubin
neonatal ABO hemolytic disease
serological hemolysis three tests
