ABO新生儿溶血病患儿母亲血清中IgG亚类水平检测的临床意义

目的探讨O、RhD(+)孕妇血清中IgG亚类水平与新生儿溶血病(HDN)的关系。方法筛选血清IgG抗A(B)效价≥64的O型、RhD(+)孕妇112例,采用ELISA法对其中69例发生HDN的母亲(A组)及其ABO-HDN患儿(B组)、43例有HDN风险但未发生HDN孕妇(C组)及其分娩的健康新生儿(D组)血清的IgG亚类进行定量分析,并与50例IgG抗A(B)效价正常的O型、RhD(+)孕妇(E组)所测相应结果进行对照。结果 A、C组不同IgG抗A(B)效价差异有统计学意义(P<0.05);A组血清中IgG_1、IgG_3和IgG_4的含量显著高于E组(P<0.05),IgG_1和IgG_3的含量高于C组,差异有统计学意义(P<0.05)。C组与E组比较IgG_1、IgG_2和IgG_3的含量差异无统计学意义(P>0.05);B组血清中IgG_1和IgG_3的含量显著高于D组(P<0.05);患儿血清中IgG各亚类构成与母体不完全一致,但均以IgG_1为主,患儿体内IgG_1比例(62.3%)高于母体(57.9%),差异无统计学意义(P>0.05)。结论 ABO血型系统中,母体血清中IgG_1和IgG_3的含量,尤其是IgG_1的含量与新生儿溶血病的发病密切相关,夫妇血型不合的O型血孕妇应定期检测IgG抗A(B)效价及IgG亚类水平。

The clinical significance of the concentration of IgG isoforms in maternal and infant serum in ABO heamolytic disease of newborn

Objective To investigate the relationship between the concentration of IgG isoforms in gravidas with O type,RhD（＋ ）and the incidence of heamolytic disease of newborn（HDN）.Methods 112 cases were included,which have a serum concentration of IgG anti A（B）≥64,the serum concentration of IgG isoforms were tested by ELISA in 69 cases of mothers with HDN（group A） and their newborns（group B）,43 cases of gravidas who were healthy but under the risk of HDN（group C） and their newborns（group D）,50 cases of healthy gravidas with type O,RhD（＋ ）（group E） as normal control.Results There were significant differences of serum concentration of IgG isoforms between group A and C（P0.05 ）;the concentration of IgG_1,IgG_3 and IgG_4 in group A was higher than that in group E（P0.05）;the serum concentration of IgG_1 and IgG_3 in group A was higher than that in group C with statistical different（P0.05）,there was no statistical significance of these data between group C and group E（P0.05）.The serum concentration of IgG_1 and IgG_2 in group B was obvious higher than that in group D（P0.05）.The proportion of IgG isoforms in infants＇serum was different from their mothers,IgG_1 was much higher with 62.3%in infants than 57.9%in their mothers,but there was no difference（P0.05）. Conclusion The concentration of IgG_1 and IgG_3,especially IgG_1 is positive correlated with the incidence of HDN.In ABO blood type system,the gravidas with O blood type need to test the concentration of IgG isoforms at regular intervals when blood type is incompatible to their husbands.