不规则抗体致同种免疫溶血性疾病与临床研究进展

不规则抗体指ABO血型系统以外的抗体，临床上多因妊娠或输血等同种免疫刺激产生，也可由自身免疫性、药物诱发性产生，多为IgG和／或IgM性质的抗体，可不同程度地导致临床血型鉴定困难、疑难配血、新生儿溶血病及临床溶血性输血反应等，因而输血前或产前进行血型不规则抗体筛选和鉴定非常必要。对于无法鉴定的疑难标本，可在血清学水平基础上结合流式细胞仪分析结果，以及通过PCR和PCR—SSP等分子生物学技术，从母体血浆中抽提胎儿游离DNA基因分型或疑难配血患者基因分型，以进一步预测胎儿发生新生儿溶血病的可能性及为疑难配血患者提供合适的血液，以备临床采取措施早期防治不规则抗体导致的同种免疫溶血性疾病，实现优生优育和降低输血反应。本文就红细胞系统不规则抗体的产生原因、种类、实验室检测、致病机制、临床症状和目前的研究进展进行了综述。

Immune Hemolytic Diseases Caused by Irregular Antibodies and Its Research Advance in Clinic

The irregular antibodies are other than antibodies from ABO blood group system because of pregnancies and blood transfusions, clinical autoimmune, drug-induced etc. The irregular IgG and/or IgM antibodies emerge and lead to the difficult identification of clinical blood type, difficult matching of blood, hemolytic disease of newborn, hemolytic transfusion reaction, and so on. It is very necessary to screen and identify the irregular antibodies before blood transfusion or antepartum. For some difficult identifying samples, some detections on serological level should be done firstly, combining with flow cytometry analysis, the difficult-matching patients＇ genotypes and fetal genotypes were detected by molecular biology techniques such as PCR and PCR-SSP in order to further predict fetal hemolytic disease of newborn and to provide the right blood to difficult-matching patients, and free fetal DNA extracted from maternal plasma. So that some measures must early be taken for clinical prevention and treatment to reduce immune hemolytic reactions. In this paper, the emergence of irregular antibodies, species, laboratory testing, pathogenesis, clinical symptoms and the current research are reviewed.