茵栀黄口服液联合血浆置换孕期干预治疗ABO血型不合新生儿溶血病

目的观察茵栀黄口服液联合血浆置换治疗高效价血型抗体孕妇的疗效和安全性。方法选择2009年6月—2011年12月于解放军白求恩国际和平医院妇产科就诊的ABO抗体效价≥256的70例孕妇,按自愿原则分成治疗Ⅰ组25例、治疗Ⅱ组26例和对照组19例。对照组维生素C 3 g,维生素E 100 mg、1/d,吸氧2/d,每次20~30 min,每月治疗20 d;治疗Ⅰ组在对照组的基础上服用茵栀黄口服液20 ml/次,3/d,治疗Ⅱ组在Ⅰ组的基础上同时联合血浆置换治疗,每隔10 d 1次,每月检测抗体效价、血生化及B超监测胎儿发育情况,直至分娩,观察3组抗体效价平均下降幅度和时间、产后新生儿的情况。结果治疗Ⅰ、Ⅱ组总有效率和抗体下降时间与对照组相比,均有显著性差异（P〈0.01）,治疗Ⅰ组总有效率低于治疗Ⅱ组,抗体效价降低时间长于治疗Ⅱ组,两组比较差异有统计学意义（P〈0.05）。治疗Ⅰ、Ⅱ组新生儿溶血率降低、黄疸症状减轻。结论茵栀黄口服液联合血浆置换用于孕期降低血型抗体效价,早期干预治疗具有很好的效果,对孕妇和胎儿是安全的。

Early Intervention of Yinzhihuang Oral Liquid Combined with Plasma Exchange in Treatment of Maternal-fetal Hemolytic Disease of Newborn Induced by ABO Blood Group Incompatibility

Objective To assess the efficacy and safety of early intervention by Yinzhihuang oral liquid combined with plasma exchange in treatment of hemolytic disease of newborn（ HDN）. Methods Seventy pregnant women with high antibody titer（ ABO≥256） during June 2009 and December 2011 were divided into treatment group Ⅰ（ n = 25）,treatment group Ⅱ（ n = 26） and control group（ n = 19） based on voluntary principles. The control group was given VC 3g,VE 100mg 1 /d and oxygenuptake bid 20- 30 min at a time with 2 /d,and therapy was 20 d every month; base on the treatment for control group,treatment group Ⅰ was given Yinzhihuang oral liquid 20ml tid; while treatment group Ⅱ was given Yinzhihuang oral liquid combined with plasma exchange 1 time for every 10 d based on the treatment for treatment group Ⅰ. The mean serum antibody titer and blood biochemistry were detected,and status of foetus intrauterine growth were monitored until childbirth by using type-B ultrasonic. The mean decrease range of antibody titer and time, and neonatal conditions in the three groups were observed. Results The total effective rate and the decrease time of anti-body titer in treatment groups were significant differences compared with those in control group（ P ＆lt; 0. 01）. In treatment group Ⅰ,the total effective rate was significantly lower,and the decrease time of antibody titer was significantly longer, compared with those in treatment group Ⅱ（ P ＆lt; 0. 05）. The hemolysis rate was reduced,and icterus symptoms were relieved after treatment in group Ⅰ and Ⅱ. Conclusion Yinzhihuang oral liquid combined with plasma exchange is safe and effective for early intervention in treatment of HDN induced by blood type incompatibility,and also safe for pregnant women and foetus.