ABO新生儿溶血病早期诊断指标的回顾性分析

目的:探讨ABO-HDN早期诊断指标的特征及临床价值。方法:分析280例ABO溶血病筛查的新生儿三项诊断试验结果与初检时间、同期的血常规以及血清胆红素检测指标。结果:99例诊断为ABO-HDN阳性,其中A型54例,B型45例,血型分布差异无统计学意义(P>0.05);A型、B型HDN阳性组与HDN阴性组Hb水平差异有统计学意义(P<0.01),但99例HDN阳性组不同血型、不同初检日期Hb水平差异无统计学意义(P>0.05)。不同初检日期的HDN阳性率差异无统计学意义(P>0.05),若只分析病理性黄疸患儿,不同初检日期的HDN阳性率差异亦无统计学意义(P>0.05);所有HDN阳性诊断模式中的初检日期无明显差异(P>0.05);直抗、游离试验结果与初检天数差异无统计学意义(P>0.05);所有ABO-HDN阳性患儿出现病理性黄疸占45.45%(45/99),HDN阳性与阴性的间胆与总胆比值差异有统计学意义(P<0.05);而总胆红素、直接胆红素与间接胆红素未见明显差异(P>0.05)。若只分析病理性黄疸患儿,HDN阳性与HDN阴性的各胆红素指标均未见明显差异(P>0.05)。结论:轻中度的贫血以及间胆与总胆比值是早期ABO-HDN诊断的辅助指标,且大多贫血不呈进行性加重,临床上不应以出现病理性黄疸后再考虑筛查ABO-HDN。抗体释放试验是最灵敏的、也是疾病进展后最重要的确诊指标。

Retrospective analysis of early diagnostic markers in ABO incompatible hemolytic disease of the newborn

Objective:To investigate the characters and clinical significance of early diagnostic markers in ABO incompatible HDN. Methods:Some laboratory data such as blood routine tests and serum bilirubin and the first diagnostic date in 280 cases neonates needed to detect for ABO-HDN were collected and analyzed. Results:Ninety-nine cases were diagnosed as ABO-HDN,including 54 case of type A(54.5%),45 case of type B(45.5%),and the distribution of blood were not significantly different between the two types(P>0.05).The levels of plasma hemoglobulin in type A or type B ABO-HDN were significantly different compared with none-HDN(P<0.01),but the levels of hemoglobulin in all ABO-HDN were not significantly different in different blood type as well as different first diagnostic date(P>0.05).The positive rates of ABO-HDN as well as that of ABO-HDN with developed pathological jaundice were not significantly different in different first diagnostic date(P>0.05).The distribution of the first diagnostic date in all positive diagnostic models of ABO-HDN and the positive rates of direct antiglobulin test and that of serum free hemolytic antibody test were not significant different(P>0.05).The percent of neonates developed pathological jaundice in all ABO-HDN was 45.45%(45/99),the ratio of indirect bilirubin to total bilirubin was significantly different between ABO-HDN and non-HDN neonates(P<0.05),but the levels of total bilirubin,direct bilirubin and indirect bilirubin were not significantly different between ABO-HDN and non-HDN neonates(P>0.05)as well as between ABO-HDN and non-HDN neonates developed pathological jaundice. Conclusion:Mild or medium anemia can be the early auxiliary index for ABO HDN and progressive exertional anemia is seldom.Clinical decision to screen ABO-HDN by laboratory investigation should not be delayed until neonates developed pathological jaundice.Antibody elution test is the most sensitive and important diagnostic markers during the progression of ABO-HDN.