静脉注射丙种球蛋白治疗新生儿ABO溶血病22例疗效观察

为探讨静脉注射丙种球蛋白 (IVIG)对新生儿 ABO溶血病的疗效 ,随机将 42例 ABO溶血病新生儿分为 IVIG治疗组和常规治疗组 ,两组均于治疗前和治疗后分别查血红蛋白 ,网织红细胞、血清胆红素及 Ig G.A.M。结果 :IVIG组在皮肤黄疸消退 ,降低血清胆红素疗效方面均明显优于常规组 (P<0 .0 1 ) ,Ig G水平明显提高 (P<0 .0 1 ) Ig A与 Igm水平无变化 (P>0 .0 5 ) ;常规组在治疗 3～ 4天后血红蛋白水平显著低于治疗前 (P<0 .0 1 ) ,而 IVIG组血红蛋白水平与治疗前无显著性差异 (P>0 .0 5 ) ,IVIG投药量为 40 0 mg/kg.d、6 0 0 mg/kg.d、80 0 mg/kg.d,三种剂量均显示有效 ,以 80 0 mg/kg.d组退黄效果明显 ,但比较无统计学意义 (P>0 .0 5 )。结论 :IVIG对新生儿 ABO溶血病有确切疗效 ,有较高的临床使用价值     

不同剂量丙种球蛋白治疗ABO溶血病疗效比较

目的比较不同剂量静脉注射用丙种球蛋白(IVIG)治疗新生儿ABO血型不合溶血病的疗效。方法将出生后2 d内确诊的新生儿ABO血型不合溶血病患儿随机分为单剂组(70例)和多剂组(66例),单剂组静脉滴注IVIG 1 g/(kg.d),1 d;多剂组剂量500 mg/(kg.d),共3 d。生后第42天随访血红蛋白及生长发育等情况。结果单剂组需要双面光疗时间较多剂组短(P<0.01),两组患儿第42天血红蛋白水平、贫血发生率差异无显著性,两组患儿均不需换血治疗,均未发生胆红素脑病。结论单次大剂量IVIG(1 g/kg)治疗新生儿ABO血型不合溶血病是一种高效、经济、安全的治疗方法。     

同剂量静脉用丙种球蛋白不同方法治疗ABO溶血病的临床观察

为探讨同剂量静脉用丙种球蛋白 (IVIG)不同方法治疗ABO溶血病的疗效。1 7例病人分 2 5gIVIG用 1天组 7例和 1 2 5gIVIG用 2天组 1 0例 ,两组均保持原有的综合治疗。结果显示 ,治疗第二天 ,2 5g组血总胆红素下降 75 2± 1 9 7μmol L ,1 2 5g组下降 2 5 5± 1 1 7μmol L ,P <0 0 0 1。治疗第四天及第七天分别下降 1 2 2 1± 7 4μmol L、81 8± 0 4μmol L及 45 5± 49μmol L、1 1 8 6± 2 1 μmol L(P <0 0 0 1和P <0 0 5)。因此 ,2 5g组 (即IVIG 70 0mg～ 1 0 0 0mg kg)只用 1次疗效优于同剂量分次应用     

静脉内丙种球蛋白两种疗法治疗新生儿ABO溶血病的疗效研究

目的 探讨应用静脉内丙种球蛋白(IVIG)治疗新生儿ABO溶血病两种疗法的效果.方法 将我院新生儿病房2003～2006年间收治的新生儿ABO溶血病患儿102例随机分为两组:对照组(50例)采用IVIG 3 d疗法[0.4 g/(kg·d),连用3 d];治疗组(52例)采用IVIG 1 d疗法[1 g/(kg·d),单剂静脉滴注],两组进行疗效对比.结果 治疗组在治疗后48 h、72 h血清总胆红素较对照组降低(P＜0.05),黄疸消退时间与对照组比较明显缩短(P＜0.01).结论 1 d疗法在疗效方面明显优于3 d疗法,采用IVIG1g/(kg·d)单剂静脉滴注是治疗新生儿ABO溶血病更有效、经济、简便的治疗方案.     

静脉注射丙种球蛋白治疗新生儿ABO溶血病的应用价值初探

目的初步评估静脉注射大剂量丙种球蛋白治疗新生儿ABO溶血病的使用价值。方法回顾性分析2000年1月至2004年12月入我科的48例新生儿ABO溶血病资料。将病例分为单纯光疗组(对照组)与光疗+丙种球蛋白组(治疗组),分析两组间基本状况(年龄、性别等)及黄疸程度(血清总胆红素、间接胆红素),差异无显著性,具有可比性。同时分析两组光疗时机、黄疸消褪时间、住院时间、医疗总费用、检验费、药费的差异。结果1.光疗时机:对照组与治疗组分别为58.33±24.88小时、37.93±22.82小时,P>0.05,差异无显著性意义。2.褪黄效果:对照组与治疗组褪黄时间及住院时间分别4.0±1.49天、4.14±0.95天、6.3±1.89天、6.21±2.01天,P>0.1,差异无显著性。3.两组住院总费用、检验费、药费比较,P值均小于0.05,差异有显著性意义。结论1.光疗是治疗新生儿ABO溶血病简单有效的方法。2.静脉注射大剂量丙球可减轻溶血发生,但无清除胆红素作用,当黄疸明显时,并不缩短褪黄及住院时间,若使用对象、使用时机不当,只会增加医疗资源浪费及增加病人经济负担。     

静脉注射用丙种球蛋白治疗新生儿ABO溶血病对血清免疫球蛋白的影响

目的通过新生儿ABO溶血病使用静脉注射用丙种球蛋白(IVIG)前后的血清免疫球蛋白指标变化观察,探讨IVIG使用对新生儿血清免疫球蛋白的影响.方法随机将新生儿ABO溶血症患儿分为两组,常规治疗+IVIG为治疗组,常规治疗为对照组,IVIG治疗剂量为800～1000mg/kg,分别测定使用IVIG前,使用IVIG后2 d、28 d、2个月体内血清免疫球蛋白数值并与对照组对照.结果治疗组IgG、IgM在用药后2 d、IgA在用药后28d与对照组比较差异有显著性,其余指标两组差异无显著性.结论IVIG治疗新生儿ABO溶血病不会使新生儿IgG的合成受抑制,但使IgM、IgA的合成在短期内受到抑制.     

静脉注射大剂量丙种球蛋白治疗新生儿ABO溶血病的疗效观察

探讨大剂量静注丙种球蛋白治疗新生儿ABO溶血病的疗效 ,对 50例患儿随机分为观察组 2 6例 ,对照组 2 4例。观察组在对照组综合治疗基础上 ,给予静脉注射大剂量丙种球蛋白 1g kg .d ,连用 1～ 3天。结果 :血总胆红素值降低、黄疸完全消退、胆红素恢复正常所需时间、血红蛋白水平 ,两组差异显著 (P <0 0 1 )。结论 :大剂量静注丙种球蛋白可阻止溶血 ,降低胆红素浓度 ,减少胆红素脑病的发生 ,对重症病例可起替代换血的作用。     

静脉注射用丙种球蛋白治疗新生儿ABO溶血病对血清免疫球蛋白的影响

目的 通过新生儿ABO溶血病使用静脉注射用丙种球蛋白(IVIG)前后的血清免疫球蛋白指标变化观察，探讨IVIG使用对新生儿血清免疫球蛋白的影响。方法 随机将新生儿ABO溶血症患儿分为两组，常规治疗 IVIG为治疗组，常规治疗为对照组，IVIG治疗剂量为800～1000mg／kg，分别测定使用IVIG前，使用IVIG后2d、28d、2个月体内血清免疫球蛋白数值并与对照组对照。结果 治疗组IgG、IgM在用药后2d、IgA在用药后28d与对照组比较差异有显著性，其余指标两组差异无显著性。结论 IVIG治疗新生儿ABO溶血病不会使新生儿IgG的合成受抑制，但使IgM、IgA的合成在短期内受到抑制。     

静脉用免疫球蛋白治疗ABO溶血病的临床探讨

探讨静脉用免疫球蛋白治疗 ABO溶血病的疗效。方法 2 3例病人分对照组 1 2例 ,治疗组 1 1例 ,治疗组在对照组综合治疗基础上 ,给予静脉用免疫球蛋白。结果显示 ,治疗第二天 ,对照组血总胆红素值上升 1 2 .9±1 .1 umol/L,治疗组血总胆红素值降低 5 3.4± 2 2 .0 umol/L(P<0 .0 0 1 )。治疗第四天及第七天 ,较治疗前分别下降 6 1 .0± - 3.8umol/L 及 1 2 6 .8± 1 5 .3、1 2 1 .8± 1 1 .2 umol/L (<0 .0 0 1 )。因此 ,静脉用免疫球蛋白辅助治疗 ABO溶血病可加速胆红素下降速度 ,减少换血机率     

大剂量静脉滴注丙种球蛋白治疗新生儿溶血病的疗效分析

静脉滴注丙种球蛋白(IVIG)能有效地防治新生儿同种免疫性血小板减少症.新生儿溶血病与新生儿同种免疫性血小板减少症具有相同的发病机理.基于这一理论,国外研究表明,新生儿应用大剂量IVIG能有效地治疗新生儿溶血病,但患儿出现黄疸后应用大剂量IVIG能否减轻黄疸、降低贫血的发生率,报道较少见.     

High-dose intravenous gammaglobulin therapy for neonatal immune haemolytic jaundice due to blood group incompatibility.

Three newborn infants who developed hyperbilirubinemia due to blood group incompatibility were treated with high-dose gammaglobulin. Hyperbilirubinemia was caused by Rhesus (Rh) incompatibility (anti-E + anti-c) in Infant 1 and ABO incompatibility (anti-B) in Infants 2 and 3. Hyperbilirubinemia was refractory to conventional phototherapy but responded well to intravenous gammaglobulin (IVGG) at a dose of 1 g/kg in all infants. No adverse effects were observed. These findings suggest that high-dose IVGG may be useful in the treatment of hyperbilirubinemia due to isoimmune haemolytic disease resistant to phototherapy.     

High-Dose Intravenous Gammaglobulin Therapy for Neonatal Immune Haemolytic Jaundice due to Blood Group Incompatibility

ABSTRACT. Three newborn infants who developed hyperbilirubinemia due to blood group incompatibility were treated with high-dose gammaglobulin. Hyperbilirubinemia was caused by Rhesus (Rh) incompatibility (anti-E + anti-c) in Infant 1 and ABO incompatibility (anti-B) in Infants 2 and 3. Hyperbilirubinemia was refractory to conventional phototherapy but responded well to intravenous gammaglobulin (IVGC) at dose of 1 g/kg in all infants. No adverse effects were observed. These findings suggest that high-dose IVGG may be useful in the treatment of hyperbilirubinemia due to isoimmune baemolytic disease resistant to phototherapy.     

不同血源对ABO溶血病外周动静脉同步换血疗效的比较

目的 　探讨不同血源对ABO溶血病外周动静脉同步换血的疗效。方法　对 2 3例ABO溶血病患儿依时间分为二组 ,同型血组和混合血组。同型血组采用与患儿血型相同的血为血源换血 ,混合血组采用AB型血浆和O型洗涤红细胞混合血为血源换血。换血途径均采用外周动静脉。结果　同型血组和混合血组换血后总胆红素下降显著 ,4 50 0± 1 4 4 2 4 μmol/L ,2 54 56± 87 58μmol/L ,393 4 8± 1 6 7 4 6vs2 36 6 0± 97 79μmol/L ;两组的换出率分别是 :4 2 2 5± 1 3 91 % ,38 4 6± 1 3 1 6 % ,t =0 70 ,P >0 0 5。换血后两组的血细胞 ,红细胞压积 (HCT) ,电解质 ,白蛋白改变相同。换血后无明显不良反应。结论　同型血和混合血为血源换血疗效相同 ,在紧急情况下采用同型血换血可以节约时间。     

Neonatal ABO incompatibility. Complicated by hemoglobinuria and acute renal failure

The authors present two infants with isoimmune hemolytic disease due to ABO incompatibility complicated by massive hemoglobinuria and secondary acute renal failure. This represents an incidence of 0.36% of all neonates with ABO hemolytic disease in the author's newborn population. Only two patients have been reported previously to have similar complications. Analysis of data of these four infants revealed the clinical characteristics of this complication of ABO incompatibility: 1) very low frequency; 2) early onset of hemoglobinuria (first voided urine) and of acute renal failure (first 2 days of life); 3) lack of correlation between the clinical presentation of hemolytic disease and appearance and severity of renal failure; 4) complete recovery of renal functions following intravenous fluid administration; and 5) normal renal radiologic investigations.     

碳氧血红蛋白测定对新生儿黄疸诊断的价值

目的：探讨碳氧血红蛋白测定在新生儿黄疸诊断中的临床价值。方法：189例新生儿黄疸患儿(新生儿溶血病75例,感染52例,颅内出血32例,晚发母乳黄疸30例)及142例对照组患儿同步测定动脉化毛细血管血碳氧血红蛋白(COHb)和血清总胆红素(STB);溶血组予大剂量静脉免疫球蛋白治疗后测定COHb及STB,应用SAS6.12统计软件进行处理。结果：溶血组COHb及STB分别为(3.64±0.83)%,330.84±77.15μmol/L,显著高于对照组的(2.38±0.35)%和130.18±32.86μmol/L(P<0.01);颅内出血组COHb及STB分别为(2.48±0.53)%,184.15±29.35μmol/L,高于对照组的(2.24±0.32)%及112.11±17.45μmol/L(P<0.05);感染及母乳黄疸组STB分别为286.71±45.66μmol/L,299.15±44.14μmol/L,显著高于对照组146.23±31.26μmol/L及57.33±7.83μmol/L(P<0.01),而COHb为(2.36±0.50)%及(1.84±0.49)%与对照组(2.20±0.39)%及(1.67±0.43)%比较,差异无显著性(P>0.05)。溶血性高间胆组STB低于非溶血性高间胆组(P<0.01),而COHb显著高于后者(P<0.01)。溶血组大剂量静脉免疫球蛋白治疗前后COHb分别为(3.64±0.83)%及(2.68±0.51)%,STB分别为330.84±77.15μmol/L及230.18±42.96μmol/L,治疗前后比较差异有显著性(P<0.01)。结论：COHb测定可作为胆红素产量的指标,有助于新生儿黄疸病因诊断及指导治疗。     

Hydrops fetalis due to ABO incompatibility

Hemolytic disease of the newborn due to ABO incompatibility was first observed by Halbrecht in 1944. This entity has a spectrum ranging from minimal hemolysis requiring no therapy, as is the case in most instances, to severe hemolytic disease requiring aggressive management including exchange transfusion in a small percentage of cases. An extreme degree of hemolytic disease of the newborn due to ABO incompatibility, i.e., hydrops fetalis, has not been well documented in the English literature. We present a case of hydrops fetalis due to ABO incompatibility. The severity of hemolytic disease due to ABO incompatibility can be forecast when indicated in selected cases.     

A trial with high-dose gamma globulin therapy in 3 children with hyperbilirubinemia in rhesus incompatibility

The influence of high-dose intravenous gammaglobulin (HDivGG) on the course of hyperbilirubinemia was investigated in three newborn infants with rhesus hemolytic disease. In addition to phototherapy and appropriate hydration all children received gammaglobulin (Polyglobulin N, Tropon-Cutter, Cologne, FRG) at a dose of 500 mg/kg body weight intravenously. All three infants showed a marked decrease in bilirubin levels after HDivGG. In two cases exchange transfusion could be avoided. In the third an elevated bilirubin level after blood exchange dropped following HDivGG, and a further exchange transfusion became unnecessary. The suspected effect of HDivGG in Rhesus incompatibility may be due to a blockade of Fc-receptors of the reticuloendothelial system, which prevents further hemolysis and bilirubin production. We propose, that the efficacy of this new mode of treatment should be evaluated in a controlled study.     

Hemolytic disease of the newborn due to isoimmunization with anti-E antibodies: a case report

Minor blood group hemolytic disease is extremely rare, since the overall potency of minor blood groups in inducing antibodies is significantly lower when compared with that of Rh (D) antigen. We hereby report a very rare case of severe neonatal anti-E hemolytic disease due to E minor blood group incompatibility. A term newborn born to a 27-year-old, gravida 3, para 3 mother was referred due to a high and increasing serum bilirubin level despite phototherapy on the 4th day of life. On admission physical examination was normal except for the jaundice, and results of the laboratory investigation demonstrated a moderate-to-severe anemia (hemoglobin 7.8 g/dl) and a severe hemolytic hyperbilirubinemia (serum total and indirect bilirubin levels 36 mg/ dl and 32.8 mg/dl, respectively; reticulocyte count 15%; and a positive direct antiglobulin test). As there was no apparent cause of the hemolytic disease such as Rh or ABO incompatibilities, further investigation (a positive indirect antiglobulin test and a positive irregular anti-E antibody in both the patient and mother, and minor blood group antigen profiles in family members compatible with E minor blood group isoimmunization) revealed the presence of anti-E hemolytic disease due to E minor blood group incompatibility. Two exchange transfusions with a 12-hour-interval were performed with minor blood group compatible fresh whole blood, and the patient was discharged in a healthy condition on the 10th postnatal day. If the most common causes of severe neonatal hemolytic disease such as Rh and ABO incompatibilities cannot be demonstrated in a newborn with significant hemolytic hyperbilirubinemia, anti-E hemolytic disease should strongly be considered in differential diagnosis. It should be kept in mind that a very severe from of minor group antibody hemolytic disease characterized by anemia and severe hyperbilirubinemia many exchange transfusions may be encountered during the course of the disease.