1350例新生儿溶血三项试验的血清学检测分析

摘要

目的：探讨由母婴血型不合引起的新生儿溶血病（ HDN）的血型分布及其溶血三项试验在HDN诊断中的价值。方法：对2014年1月到2016年1月临床送检的O型或Rh阴性的产妇脐带血标本及高胆红素血症的新生儿血液标本用微柱凝胶检测卡进行溶血三项试验，并对结果进行统计学分析。结果：（1）1350例标本中，母婴血型不合者占918例，确诊为HDN的有569例，阳性率为62.0％。569例HDN三项试验结果为：直抗试验阳性率为27.9％（159／569），游离抗体试验阳性率为86.5％（492／569），抗体释放试验均为阳性。其中直抗阴性＋游离阳性＋释放阳性的组合与其他各组合相比有统计学差异（P＜0.05）。（2）918例血型不合标本中，ABO HDN阳性率为73.8％（551／747），Rh HDN阳性率为10.5％（18／171），两者差异有统计学意义（ P＜0.05）。（3）747例ABO血型不合标本中， A型阳性率为80.0％（280／350）， B型阳性率为68.3％（271／397），两者差异有统计学意义（P＜0.05）。（4）171例Rh血型不合标本中，Rh D阳性率为17.7％（14／79），Rh E阳性率为6.8％（4／59），Rh C阳性率为0（0／33），三者差异有统计学意义（P＜0.05）。结论：抗体释放试验敏感度最高，是判定HDN最有力的证据。母婴ABO血型不合引起的HDN发生概率明显高于Rh不合，A型血患儿发生HDN的概率明显高于B型血患儿，Rh D不合引起的HDN发生概率明显高于Rh E和Rh C。%Objective:To explore blood type distribution of newborns hemolytic disease ( HDN ) caused by maternal and neonatal blood type incompatibility and analyze the value of hemolysis three trials in the diagnosis of HDN.Methods:Hemolysis three trials of type O or Rh negative maternal cord blood samples and hyperbilirubinemia of the newborn blood samples from January 2014 to 2016 were detected by micro-column gel test cards.Then the results were statistically analyzed.Results:(1) There were 918 cases of maternal and neonatal blood type incompatibility in all 1350 cases.569 cases were detected HDN positive with the rate of 62%( 569/918).Among 569 cases,the positive rate of direct anti-globulin test,free antibody test and antibody released test were 27.9%(159/569),86.5%(492/569) and 100% respectively.There was statistical difference of the combination of direct anti-globulin test negative,free antibody test positive and antibody released test positive compared with other combinations ( P<0.05 ).( 2 ) There was statistical difference of HDN positive rate between ABO 73.8%(551/747) and Rh 10.5%(18/171)in 918 cases of blood type incom-patibility.(3)There was statistical difference between A positive rate of 80%(280/350) and B positive rate of 68.3%(271/397) in 747 cases of ABO incompatibility.(4)There was statistical difference among RhD positive rate of 17.7%(14/79),RhE positive rate of 6.8%(4/59) and RhC positive rate of 0(0/33).Conclusion: Antibody released test was the most sensitive test in hemolysis three trials to diagnose HDN.The probability of HDN positive caused by maternal and neonatal ABO blood type incompatibility was significantly higher than Rh.The probability of HDN positive with type A newborns was significantly higher than type B.The probability of HDN positive caused by RhD blood type incompatibility was significantly higher than RhE and RhC.