产前检测抗体预防母儿ABO血型不合新生儿溶血病259例临床观察

目的:观察母儿血型不合孕妇产前抗体效价水平并以此指导临床用药预防新生儿溶血病。方法:选择夫妇双方ABO血型不合259例,孕期自16周开始进行抗体效价动态检测,抗体效价≤1∶32者为正常,只动态观察,不做干预治疗;对于抗体效价≥1∶64者,孕期给予药物治疗,同时继续动态监测抗体效价。分娩后追踪观察全部新生儿的黄疸程度及转归。结果:夫妇双方ABO血型不合者259例,初次检测孕妇血清抗体效价滴度=1∶32者195例,占75.29%,≥1∶64者64例,占24.71%,经治疗转为正常者36例,占56.25%。在动态监测过程中新增抗体效价≥1∶64者4例,至妊娠36周以后的最后一次抗体效价滴度作为统计效价,≥1∶64者共有32例,占12.36%,其中1∶64者17例,1∶128者12例,≥1∶256者3例。新生儿发生溶血者8例,发病率3.13%,病理性黄疸者18例。结论:新生儿溶血病发病率与抗体效价水平呈正相关,但孕期抗体效价正常者也可发病,且抗体效价≥1∶256者新生儿发病时间也可能延迟。

Clinical observation of detecting the antibody of 259 pregnant women with ABO-incompatible to prevent hemolytic disease of newborn

Objective:To prevent the hemolytic disease of the newborn by observing the antibody level of pregnant serum with ABO-incompatible.Methods: The antibody level of 295 pregnant women with ABO-incompatible were detected since the 16th week of gestation.It was regarded as normal if their antibody's titer≥1∶32.While continue to observe without treatment.To apply medication to those whose antibody level ≥1∶64.accompanied by dynamic detection of their antibody's titer.The degree of neonatal jaundice and the prognosis of all the newborn were evaluated after they were born.Results:Among the 259 cases with ABO-incompatible,in the initial detection,of which,namely,their antibody's titer of 195cases(75.29%) was 1∶32 and 64 cases(24.71%)≥1∶64.36 cases(56.25%) returned to normal after the treatment..Based on final detection after 36 weeks of gestation,the antibody's titer of 32 cases(12.36%).were≥1∶64,17 cases of them were 1∶64,12 cases of them were 1∶128 and 3 cases of them were≥1∶256 respectively.8 newborns occurred the hemolytic disease,incidence rate was 3.13% and 18 newborns were accompanied with the neonatal jaundice.Conclusion:The incidence of newborn hemolytic disease is positive correlated with the antibody level.However,it can occurred in newborn with normal antibody level during pregnancy as well.Furthermore,the onset time of the hemolytic disease can be also postponed when the antibody level of newborn≥1∶256.