母儿血型不合溶血病的免疫学基础

母儿血型不合引起的围生儿溶血病是妊娠同种免疫病之一 ,其中以ＡＢＯ及Ｒｈ血型系统为多见。在 2 0世纪初就有学者如Ｄｉｅｎｓｔ在 190 5年 ,ＭｃＱｕａｒｒｉｅ在 192 3年 ,Ｑｔｔｅｎ ｂｕｒｇ在 192 3年提出 ,妊娠期母体和胎儿的某些疾病可能是母—胎间血型不合造成的。随着免疫学的进展 ,对母儿血型不合的围生儿溶血病的病因、发病机制有了进一步的认识。简单而言 ,免疫是机体识别“非己”的过程 ,主要功能为免疫防御、自身稳定和免疫监视。根据免疫反应可分为非特异性免疫和特异性免疫。前者是机体对任何抗原物质均能发挥对抗作用的…     

人类白细胞抗原DRB基因型及其与妊娠期糖尿病的相关性研究

目的：探讨人类白细胞抗原（human leukocyte antigen,HLA)DRB各基因型在妊娠期糖尿病（GDM）孕妇中的分布,及其与GDM发病的相关性。方法：采用序列特异性引物聚合酶链反应技术,对GDM孕妇30例（GDM组）及同期入院的正常健康孕妇40例（对照组0的HLA－DRB各基因型的分布进行检测,并对HLA－DRB各基因型与GDM的相关性进行研究。结果（1）GDM组HLA－DR6（13）等位基因频率（12％）明显高于对照组（％,P＜0．05）,GDM组HLA－DR3（8％）及HLA－DR9（23％）等位基因频率与对照组（4％,16％）比较,均有增高趋势,但差异均无显著性（P＞0．05）,GDM组HLA－DR2（15）和HLA－DR51等位基因频率均为10％,较对照组（24％,38％）明显降低（P＜0．05）,（2）孕妇为HLA－DR3基因型或HLA－DR16（13）／DR9基因杂合型时,其GDM病情较重风险比（RR）分别为27．1和8．5,且产后血糖多未恢复正常,结论：（1）HLA－DR6（13）基因型可能与GDM易感性相关,HLA－DR2（15）,HLA－DR51基因型可能与GDM保护性相关,（2）DLA－DR3,HLA－DR6（13）／DR9基因型与GDM病情严重程度有相关性,并可能影响GDM孕妇产后血糖的恢复。     

1例冷凝集素致红细胞计数失误的分析

本科遇见1肺炎支原体患儿,行血常规血型检查时因冷凝集素过高引起红细胞计数严重失真及血型定型失误,报道如下。1临床资料秦某某,女,4岁咳嗽10余天于2011年3月17日入院,病程较长,出现咳嗽,为阵发性,病初有过发热,体温具体不详,无无呕吐,腹泻,曾在我院门诊治疗（予头孢噻肟钠、头孢哌酮舒巴坦钠抗炎,喜炎平抗病毒等对症支持治疗）,症状反复,今来我院门诊就诊,     

孪生儿一人患新生儿ABO血型不合溶血病

我院收治相同血型的单卵双胎孪生儿中一人因母子血型不合患新生儿ABO血型不合溶血病，报告如下。     

人类组织相容抗原免疫遗传与妊高征发病关系的探讨

选择４０对妊高征夫妇及正常对照组１００例，对其人类组织相容性抗原中与Ｄ区相关抗原（ＨＬＡ－ＤＲ）频率分布、纯合型频率及夫妇间ＨＬＡ－ＤＲ抗原共享进行了检测。结果显示：与正常对照组相比，妊高征患者ＨＬＡ－ＤＲ＿４频率有极显著的增加（Ｐ＜０．００１），妊高征患者夫妇ＨＬＡ－ＤＲ共享有明显提高（Ｐ＜０．０１），其中尤以ＤＲ＿４抗原共亨率最高（Ｐ＜０．０００１），然而，ＨＬＡ－ＤＲ及ＤＲ＿４纯、杂合型频率两组间无明显差异。结果表明，妊高征的遗传易感性可能与ＤＲ＿４有关，其相关性推测可能是由于ＤＲ＿４与妊高征的疾病易感基因间连锁不平衡所致，但ＤＲ＿４是否直接充当一种免疫缺陷基因尚不能确定。     

人类白细胞抗原G基因14 bp缺失多态性与重度子痫前期发病的关系

目的 探讨人类白细胞抗原G(HLA-G)基因第8外显子14 bp缺失多态性与重度子痫前期发病的关系.方法 选择2008年10月至2009年2月在郑州大学第三附属医院妇产科住院的42例孕晚期重度子痫前期孕妇及其新生儿为重度子痫前期组.另选择同期正常孕晚期孕妇及其新生儿45例为健康晚孕组,两组孕妇均为汉族居民.采用PCR技术对两组孕妇及其新生儿进行HLA-G基因第8外显子14 bp缺失多态性的等位基因分析,分别比较两组孕妇及其新生儿之间等位基因及基因型的频率分布,通过母、儿基因型配伍,比较两组间基因型配伍频率分布的差异.结果 (1)重度子痫前期组中母、儿均为14 bp缺失纯合子(-14 bp/-14 bp)的基因型配伍的频率为14%(6/42),显著低于健康晚孕组的33%(15/45),两组比较,差异有统计学意义(P=0.038);(2)重度子痫前期组孕妇HIA-G第8外显子14 bp缺失多态性的等位基因频率、基因型频率与健康晚孕组比较,差异均尤统计学意义(P>0.05);(3)重度子痫前期组新生儿HLA-G第8外显子14 bp缺失多态性等位基因+14 bp频率为44%(37/84)、-14 bp为56%(47/84),健康晚孕组新生儿+14 bp为30%(27/90)、-14 bp为70%(63/90),两组比较,差异虽无统计学意义,但存在差异性趋势(P=0.055);重度子痫前期组新生儿(-14 bp/-14 bp)基因型频率为29%(12/42),与健康晚孕组的49%(22/45)相比,存在差异性趋势(P=0.052).结论 中国汉族孕妇中,HIJA-G第8外显子14 bp缺失多态性与重度子痫前期的发病有关;母、儿均为缺失纯合子(-14 bp/-14 bp)基因型配伍者,发生重度子痫前期的风险会降低.     

人类白细胞抗原G及其异构体mRNA在人类着床前胚胎的表达

目的研究人类白细胞抗原G（human leukocyte antigen，HLA-G）及其异构体mRNA在人类着床前胚胎的表达，探讨HLA-G在人类胚胎早期发育中的作用和意义。方法第四军医大学唐都医院妇产科生殖医学中心2003-01-2005-12期间，以体外受精-胚胎移植技术助孕过程中剩余的患者自愿捐赠的人类早期胚胎作为研究对象，采用巢式RT-PCR检测早期胚胎HLA-G及其异构体mRNA的表达。结果检测20个受精后2—3d的人类卵裂期胚胎，2、4、6、8细胞期胚胎各5个，有7个胚胎表达HLA-G及其部分的异构体mRNA。检测5个受精后4d的人类桑葚胚，全部表达HLA-G及其部分的异构体mRNA。检测25个受精后6d的扩张期囊胚，全部受检囊胚均表达HLA-G mRNA，但异构体表达不同。在受检的25个扩张期囊胚中，20个表达HLA-G1（表达率80．0％），4个表达G2（表达率16．0％），25个表达G3（表达率100％）、24个表达G4（表达率96．0％），5个表达G5（表达率20．0％），8个表达G6（表达率32．0％）。结论着床前的人类胚胎表达HLA-G及其异构体mRNA，其阳性表达胚胎的比例，随着胚胎发育的进程而增加。HLA-G异构体在人类着床前胚胎差异表达。     

胚胎单个卵裂球人类白细胞抗原基因的检测及意义

单细胞PCR技术用于胚胎植入前单基因遗传疾病的诊断已经取得成功，并且应用于对单个卵裂球人类白细胞抗原(human leucocyte antigen，HLA)基因的检测。本研究探讨单个卵裂球HLA基因的检测方法及意义。     

中国南方妇女子宫内膜异位症与人类白细胞抗原-DQA1等位基因相关性的研究

目的 探讨子宫内膜异位症（内异症）与人类白细胞抗原－DQA1（HLA－DQA1）位点等位基因的相关必琢内异症患者的遗传易感性。方法 用聚合酶链反应－序列特异性引物（PCR－SSP）技术,对51例经腹腔镜或手术证实为内异症的患者（内异症组）和44例非内异症的妇女（对照组）进行HLADQA1等位基因的基因分型。结果 HLA－DQA1＊0401基因频率内异症组（12％）明显高于对照组（0％）（P＝0．019）,而HLA－DQA1＊0301基因频率在内异症组（14％）明显低于对照组（39％）（P＝0．005,比值比＝0．253）。结论 HLA－DQAQ＊0401基因与内异症的遗传易感性相关,而HLA－DQA1＊0301基因可能是内异症的保护基因。     

人类白细胞抗原系统与病理性妊娠的相关性

人类白细胞抗原系统与病理性妊娠的相关性居中亮范丽安妊娠是一个复杂的生理过程,从免疫学上来看类似于器官移植。带有父方异体抗原成分的胚胎,对母体来说是一个移植物,母体免疫系统对此进行识别,并产生免疫应答。但就其结局而言又与器官移植不同,母体对胎儿产生保护...     

Ultrasonographic surveillance in red blood cell alloimmunization

OBJECTIVE: This study was undertaken to audit ultrasonographic measurements of fetal liver length and middle cerebral artery peak velocity in cases of red blood cell alloimmunization between 1986 and 1999. STUDY DESIGN: A total of 200 fetuses at risk for anemia because of red blood cell alloimmunization underwent ultrasonographic measurement of the length of the right lobe of the liver, 45 underwent Doppler recording of middle cerebral artery peak velocity, and 119 underwent fetal blood sampling. RESULTS: The overall survival was 188 of 200 (94%). Among 69 fetuses found to have anemia, liver length values in 64 (93%) were at the 95th percentile or greater, and the other 5 were in the upper part of the normal range. The middle cerebral artery peak velocity was > or =95th percentile in 15 of the 19 cases of anemia in which this value was measured (79%). Among those measured within 1 week of birth, all liver lengths were at least in the upper part of the normal range, with most >95th percentile, including 1 case with a cord blood hemoglobin concentration <90 g/L. CONCLUSIONS: All fetuses with anemia identified at fetal blood sampling had enlarged livers with 93% at > or =95th percentile. The peak velocity in the middle cerebral artery was abnormal in most fetuses with anemia.     

Derivated fetal haemoglobin as a marker for red cell age in the human fetus reflecting stimulated or impaired red blood cell production

We have determined whether derivated fetal haemoglobin (dHbF, consisting of glycated and acetylated HbF) can be used as a cell age marker for fetal red blood cells (RBCs). Cord blood was obtained between 19 and 39 weeks of gestation from 28 alloimmunised anaemic fetuses (23 RhD+ and 5 Kell) and from 20 non-anaemic fetuses and newborns (controls). Density gradient centrifugation was applied to 36 samples (20 RhD+, 15 controls and 1 Kell) to obtain fractions of increasing cell age. Blood samples were used for measurements of mean cellular volume (MCV), mean cell haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), pyruvate kinase activity (PK) and derivated fetal haemoglobin (dHbF) by cation-exchange HPLC. Reticulocytes were counted only in the whole blood samples. In all density gradient separated RBC fractions, the values for MCV, MCH and PK activity decreased and those of MCHC and dHbF increased with increasing density (equivalent to increasing cell age). The mean density was lower for RBCs of the anaemic RHD group (1.072+/-0.007 g/ml) than for the non-anaemic controls (1.077+/-0.005 g/ml) (p<0.05) The RBC density of the Kell sensitised fetus did not differ from those of the controls. In the control group, the values of the cell age markers in whole blood changed significantly with the gestational age, showing an increase of mean age of the erythrocyte population. The best linear relationship was found for dHbF (y=6.28+0.17*weeks; r=0.84; p<0.001). In the anaemic RhD+ fetuses, the RBC age markers did not change with gestational age; the dHbF percentages were lower, and the MCV, MCH, PK values and the reticulocyte counts were higher than in the controls (0.05相似文献   

An evaluation of red blood cell heterogeneity (increased red blood cell distribution width) in iron deficiency of pregnancy

A new classification of anemias, which is based on mean corpuscular volume and quantitative anisocytosis (red blood cell distribution width), was evaluated in 331 pregnant women on initial presentation for prenatal care. Seventy-four of them had severe iron depletion (serum ferritin level less than or equal to 10 ng/dl). Contrary to the above classification, early iron deficiency without anemia was infrequently identified by an increase in distribution width (4 of 25 patients). The distribution width was not consistently increased in the 49 anemic, iron-deficient patients; 34 were normal and would have been considered to have thalassemia minor or anemia of chronic disease according to the new classification. The distribution width was no more sensitive than the mean corpuscular volume in suggesting iron deficiency. This study does not confirm the usefulness of the new classification in the diagnosis of iron deficiency in this patient population.     

The effects of fetal exchange transfusion with a red blood cell substitute

Isovolemic exchange transfusion in the fetal lamb in utero was performed with the use of Fluosol-DA (20%), a perfluorochemical erythrocyte substitute. With maternal hyperoxygenation, a physiologic PO2 was maintained in the fetal lambs, although the total fetal oxygen content decreased as the hematocrit dropped. Because of the oxygen-carrying properties of the perfluorochemical emulsion, the fraction of fetal oxygen carried in the dissolved state increased significantly when compared with that in controls that received saline solution.     

Neonatal nucleated red blood cell counts in twins

We counted nucleated red blood cells (NRBC) per 100 white blood cells (WBC) in the umbilical cord blood from 98 twins born to 49 women with uncomplicated twin pregnancies at > or = 34 weeks of gestation to better characterize NRBC in twins. Twelve women with monochorionic (MC) placentas and 37 with dichorionic (DC) placentas gave birth at 36.7 +/- .9 and 36.5 +/- 2 weeks of gestation, respectively. All twins were born with an Apgar score of > or = 7 at 1 min. Log10 (NRBC/100 BC) in 98 twins exhibited a nearly normal distribution, and was significantly associated with gestational age for both MC (r = -0.457, p = 0.025) and DC twins (r = - 0.275, p = 0.018), and with birth weight for both MC (r = -0.682, p < 0.001) and DC twins (r = -0.336, p = 0.003). Log10 (NRBC/100 WBC) tended to be larger in smaller twins than in larger twins in the MC group, and significantly larger in smaller twins than in larger twins in the DC group (p < 0.05). Intertwin difference in Log10 (NRBC/100 WBC) was defined as the value of Log10 (NRBC/100 WBC) of the smaller twin minus Log10 (NRBC/100 WBC) of the larger twin, and became greater with increasing intertwin difference in birth weight (r = 0.411, p = 0.003). These findings suggest that neonatal NRBC reflected gestational age and birth weight in twins. This preliminary observation using a small number of twins suggests that the smaller twin may have experienced a relative lack of oxygen compared with the larger twin in utero.     

The relationship between nucleated red blood cell counts and early-onset neonatal seizures

OBJECTIVE: This study was undertaken to better define the timing of neurologic insult in neonates with early-onset seizures through evaluation of neonatal nucleated red blood cell levels. STUDY DESIGN: Medical records and the International Classification of Diseases, Ninth Revision codes were used to identify all term neonates with neonatal convulsions who were delivered at our institution (January 1, 1990-December 31, 1995). Each neonate with early-onset seizures was matched to the next 3 neonates who met the following criteria: gestational age > or =37 weeks, no early-onset seizures, birth weight > or =800 g, umbilical artery pH > or =7.25, and a 5-minute Apgar score >7. Demographic characteristics, clinical factors, and mean initial nucleated red blood cell counts were compared between groups. RESULTS: During the 6-year study period, there were a total of 36, 490 singleton term deliveries of infants who were alive at birth. Forty-five (0.1%) of these neonates had early-onset seizures. Thirty neonates with early-onset seizures met the inclusion criteria. Mean nucleated red blood cell counts (number of nucleated red blood cells per 100 white blood cells) for neonates with early-onset seizures were significantly increased compared with those of control neonates (18.4 +/- 22.0 vs 4.6 +/- 4.5; P <.0008). CONCLUSIONS: Our findings are suggestive of the hypothesis that neurologic injury leading to early-onset seizures often occurs before the intrapartum period.     

Utilization of red blood cell transfusion in an obstetric setting

The transfusion experience for a 1-year period (September 1985 to August 1986) at a tertiary referral obstetric hospital was reviewed retrospectively. During the review period 7731 mothers were delivered and 6003 patients (83%) underwent type-and-screen procedures. A total of 1057 units of red blood cells were crossmatched, and 362 of these 1057 units were transfused to 100 parturient women so that the overall crossmatch/transfusion ratio was 2.9:1. Five percent of transfused patients received 1 unit; 52% of patients received 2 units, 19% received 3 units and 24% received greater than or equal to 4 units of packed red blood cells. Major indications for transfusion were uterine atony, 27%; retained placenta, 17%; trauma, 17%, placenta previa, 7%; and abruptio placentae, 5%. In 12% of patients transfusions were done because of anemia. This study shows the value of audit and confirms that the type-and-screen procedure is an effective way of reducing the crossmatch/transfusion ratio without compromising patient care, even in high-risk patients.