新生儿溶血病早期干预治疗的临床研究

目的探讨早期大剂量免疫球蛋白静脉滴注(IVIG)治疗新生儿ABO血型不合溶血病(ABO-HDN)的疗效。方法将121例确诊HDN患儿随机分成治疗组(61例)和常规组(60例)。治疗组在常规治疗基础上给予IVIG(400mg/kg·d,2￣3次),观察两组治疗效果。结果治疗组在治疗后第3天血清总胆红素值、日均血清总胆红素降低值分别为(153.42±45.21)μmol/L和(56.49±24.05)μmol/L,均低于常规组(P<0.01);治疗组黄疸消退时间(23.51±11.19)h,累计光疗时间(3.01±0.89)h,均短于常规组(P<0.01);治疗组治疗后的血红蛋白值均高于对照组(P<0.01)。结论早期大剂量IVIG能有效阻断溶血的继续发生,快速降低血清总胆红素,降低核黄疸的发生率,大大缩短光疗时间,是早期治疗新生儿ABO-HDN的有效手段。

Clinical study of early interventions for ABO hemolytic disease of the newborn

OBJECTIVE: To investigate therapeutic effect of high-dose intravenous immunoglobulin (IVIG) for early management of ABO hemolytic disease of the newborn (ABO-HDN). METHODS: A total of 121 cases with ABO-HDN were randomly divided into treatment group (n=61) and control group (n=60). In addition to the routine treatment of the control group, IVIG were given at a daily dose of 400 mg/kg to the cases in the treatment group for 2-3 times, and therapeutic effects were evaluated and compared between the two groups. RESULTS: The serum total billirubin concentration on the third day after treatment (153.42-/+45.21 micromol/L) and mean daily serum total billirubin concentration reduction (56.49-/+24.05 micromol/L) in treatment group were lower than those in the control group (P<0.01). The jaundice resolution time (23.51-/+11.19 h) and the phototherapy time (3.01-/+0.89 h) for billirubinemia treatment in treatment group were shorter than those in the control group (P<0.01). The patients in the the treatment group had higher hemoglobin level after treatment (15.59-/+2.01 g/L) than those of the control group (P<0.01). CONCLUSION: High-dose IVIG can effectively arrest the progression of hemolytic disease, quickly reduce serum total billirubin concentration and shorten phototherapy time for early treatment of ABO-HDN.