摘要：
Objective To investigate the outcomes of fetuses with hemolytic anemia caused by red cell alloimmunization following intrauterine transfusion (IUT),and to analyze the influence of hydrops fetalis on IUT treatment.Methods A retrospective analysis was conducted on 70 fetuses,who were admitted to the Fetal Medicine Center,the First Affiliated Hospital of Sun Yat-sen University from January 2005 to May 2018,with hemolytic disease requiring IUT.Clinical data of the fetuses and the gravidas were collected and divided into hydrops group (17 cases) and non-hydrops group (53 cases) based on their conditions before IUT.Results of routine blood tests before and after the first IUT,gestational age at the first IUT,prognosis and outcomes of the fetuses were compared between two groups.t-test,rank-sum test,Chi-square test (or Fisher's exact test) and multivariant logistic regression analysis were used for data analysis.Results Totally,the 70 fetuses underwent 231 times of IUT.Compared with the non-hydrops group,the hydrops group had a significantly increased incidence of severe anemia [14/17 vs 47.2％ (25/53),x2=6.458,P=0.011],but decreased hemoglobin [(38.5 ± 21.4) vs (68.7± 19.3) g/L,t=5.471,P＜0.001] and hematocrit level [0.110 (0.044-0.246) vs 0.222 (0.077-0.299),Z=-4.390,P＜0.001] before the first IUT.After the IUT,the survival rate of the fetuses in hydrops group was significantly lower than that of the non-hydrops group [11/15 vs 94.3％ (50/53),P=0.038].There was no significant difference in gestational age at birth,birth weight,neonatal hemoglobin level at birth,the incidence of exchange transfusion,the number of blood transfusions required or the incidence of severe neonatal complication between the two groups (all P＞0.05).Logistic regression analysis indicated that the fetal hydrops was an independent risk factor for fetal survival (OR=12.8,95％CI:1.2-136.4,P=0.035).Conclusions Hydrops fetalis might reduce the survival rate of fetal hemolytic disease after 1UT.%目的 探讨宫内输血治疗红细胞同种免疫胎儿溶血病的结局,分析胎儿水肿对宫内输血治疗的影响. 方法 回顾性分析2005年1月至2018年5月于中山大学附属第一医院胎儿医学中心收治并行宫内输血的70例胎儿溶血病胎儿.收集孕妇及胎儿的临床资料,并根据宫内输血前胎儿是否出现水肿分为水肿组(17例)和非水肿组(53例),比较2组首次宫内输血前后的胎儿血常规结果、首次宫内输血孕周、胎儿结局及新生儿情况.采用t检验、秩和检验、x2检验或Fisher精确概率法,以及多因素logistic回归分析对数据进行统计分析. 结果70例胎儿中,水肿胎儿17例,非水肿胎儿53例,共进行231次宫内输血.宫内输血前,水肿组重度贫血发生率高于非水肿组[14/17与47.2％(25/53),x2=6.458,P=0.011],但血红蛋白、红细胞比容水平低于非水肿组[(38.5±21.4)与(68.7±19.3) g/L,t=5.471;0.110 (0.044～0.246)与0.222(0.077～0.299),Z=-4.390;P值均＜0.001].宫内输血后,水肿组胎儿存活率显著低于非水肿组[11/15与94.3％(50/53),P=0.038].2组胎龄、出生体重、出生时血红蛋白、生后换血、新生儿期输血次数及严重并发症发生率比较,差异均无统计学意义(P值均＞ 0.05).多因素logistic回归分析提示,胎儿水肿是胎儿存活的独立危险因素(OR=12.8,95％CI:1.2～136.4,P=0.035). 结论 胎儿水肿可降低红细胞同种免疫溶血病胎儿宫内输血的存活率.
