大剂量静脉丙种球蛋白早期应用治疗新生儿溶血病的临床研究

目的:探讨早期应用大剂量静脉丙种球蛋白(IVIG)治疗新生儿ABO溶血病(ABO-HDN)的临床疗效。方法:回顾性分析确诊ABO-HDN病例92例,均为母亲血型为O型,新生儿血型为A或B型。早期治疗组在新生儿出生后即行血型血清学试验,确诊HDN患儿即刻开始IVIG治疗;晚期治疗组在新生儿出现病理性黄疸后行血型血清学试验,确诊HDN患儿给予IVIG治疗;其余治疗无差别。观察两组疗效。结果:早期治疗组血清总胆红素高峰值明显低于晚期治疗组(P<0.001),而两组入院时血清总胆红素和住院期间血清总胆红素高峰值差异均无统计学意义(P>0.05)。两组IVIG治疗后血红蛋白(Hb)水平较治疗前均无明显下降(P>0.05),而早期治疗组Hb在治疗前后均明显高于晚期治疗组(P<0.001)。早期治疗组光疗时间,住院时间均短于晚期治疗组(P<0.001)。结论:大剂量IVIG治疗能避免患儿高胆红素血症继续进展,有效阻断溶血过程。在HDN临床症状出现之前即早期应用IVIG疗效更加显著。

Clinical study of early high-dose intravenous immunoglobulin therapy for hemolytic disease of newborn

Objective: To investigate the clinical therapeutic effect of early high-dose intravenous immunoglobulin(IVIG) on ABO hemolytic disease of newborn(ABO-HDN).Methods: 92 cases of ABO-HDN,whose blood type were A or B and their mothers’ blood type were O,were divided into early management group and late management group.The patients in early management group were performed experiment of blood group serology postnatal,while the patients in late management group were performed the same examination after the pathologic jaundice was appeared.They all received IVIG treatment immediately after the diagnosis of ABO-HDN was established.Therapeutic effects were evaluated and compared between the two groups.Results: The highest level of serum total bilirubin in early management group were significantly lower than that in late management group(P<0.001).There were no statistically significant differences in bilirubin level on admission and the highest level of bilirubin in both groups(P>0.05).The hemoglobin after treatment with IVIG had no significant decrease compared with that before treatment in both groups(P>0.05).But the hemoglobin in early management group was higher than that in late management group whatever before or after treatment with IVIG(P<0.001).The duration of phototherapy and hospitalization days were significant shorter in early management group versus late management group(P<0.001).Conclusion: High-dose IVIG can effectively prevent hyperbilirubinemia from aggravation and block the progression of hemolytic disease.Early treatment with IVIG,before obvious symptoms of ABO-HDN occur,have a better curative effect.