交换输血术对高胆红素血症新生儿血清免疫球蛋白的影响

摘要

目的 评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响.方法 对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析.结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa＜0.01),各组间IgA、IgM水平无明显差异(Pa>0.05).2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa＜0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091).3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185).4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa＜0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P＜0.01).结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响.%Objective Immunoglobulin was measured in newborns with hyperbilirnbinemia before and after exchange transfusion therapy to observe the humoral immunity status and variation,and to investigate the effect of exchange transfusion therapy on immunoglobulin in neonates. Methods The infants with hyperbilirubinemia who needed exchange transfusion therapy were divided into 4 groups according to different etiologies: ABO hemolysis group, Rh hemolysis group, sepsis group, other hyperbilirubinemia group. Blood levels of IgG, IgA andIgM were measured in each group before and after exchange transfusion and analyzed. Results 1. Before exchange transfusion, the IgG levels in ABO hemolysis group, Rh hemolysis group were higher than those in sepsis group and other hyperbilirubinemia group( Pa ＜ 0. 01 ), but there was no statistical difference in IgA, IgM levels between each group( Pa ＞0.05 ). 2. IgG levels in ABO hemolysis group and Rh hemolysis group after exchange transfusion decreased compared with those before the exchange transfusion therapy ( Pa ＜ 0.05 ), increased in single hyperbilirubinemia, but the differences were not significant ( P = 0. 387,0. 091 ). 3. The IgA levels after exchange transfusion in all 4 groups were higher than those before exchange transfusion,the differences in ABO hemolysis group, Rh hemolysis group and other hyperbilirubinema group were significant( Pa = 0. 000 ), but no statistical difference was found in sepsis group( P = 0. 185 ). 4. The IgM levels after the exchange transfusion in all 4 groups were higher than those before the exchange transfusion, and there was statistical difference in other hyperbilirubinemia group,ABO hemolysis group, Rh hemolysis group ( Pa ＜ 0. 05 ), but there was no statistical difference in sepsis group ( P = 0.081 ), however, there was statistical difference among ABO hemolysis group, Rh hemolysis group and single hyperbilirubinemia group ( P ＜ 0.01 ). Conclusions 1. In neonates with hemolysis disease,the higher IgG levels,and IgG levels can be decreased by exchange transfusion, and IgA, IgM levels can be increased ;2. The exchange transfusion therapy has no effect on IgG, IgA, IgM levels in sepsis group;3. The exchange transfusion therapy can increase IgA, IgM levels in single hyperbilirubinlimia without changes in IgG levels.