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目的探讨胎儿血型产前诊断在早期诊断ABO-新生儿溶血病(HDN)中的价值,为早期发现ABO-HDN提供依据。方法回顾性分析2013—2014年在湖州市妇幼保健院产前检查的3 777名O型血孕妇血清Ig G抗A抗B效价检测情况及妊娠结局,利用孕妇外周血中的胎儿DNA检测胎儿ABO血型,并评价其在早期诊断ABO-HDN中的应用价值。结果 3 777名O型血孕妇血清Ig G抗A抗B效价检测结果显示,ABO-HDN高风险孕妇1 175人,占31.10%,低风险孕妇2 602人,占68.90%。对其中769名高风险孕妇进行妊娠结局新生儿情况随访,胎儿血型与孕妇抗A或抗B相对应的641人,占83.36%;不相对应的128人,占16.64%。对其中新生儿血型与抗体检测相对应的高风险孕妇ABO-HDN发病率分析结果显示,抗体效价越高,ABO-HDN发生率越高(χ2趋势=23.752,P<0.01)。从血清Ig G抗A抗B效价≥1∶256的孕妇中随机选择30人,提取孕妇外周血血浆中胎儿游离DNA,利用聚合酶链反应-序列特异性引物分型检测胎儿ABO血型基因型,与胎儿出生后血型一致率为100%。结论孕妇血清Ig G抗A抗B效价检测结果在ABO-HDN产前预防中存在干扰因素,仅凭其效价高低进行ABO-HDN的早期诊断和治疗具有一定的局限性;胎儿血型产前诊断技术作为辅助诊疗手段早期诊断ABO-HDN时可有效提高诊疗水平。
Objective To investigate the value of prenatal diagnosis of fetal blood type in the early diagnosis of ABO-neonatal hemolytic disease (HDN), and to provide evidence for the early detection of ABO-HDN. Methods The serum Ig G anti-A anti-B titer and pregnancy outcome of 3 777 O-positive pregnant women who were tested in prenatal care in Maternal and Child Health Hospital of Huzhou City from 2013 to 2014 were retrospectively analyzed. The fetus was detected by fetal DNA in pregnant women’s peripheral blood ABO blood group, and evaluate its value in the early diagnosis of ABO-HDN. Results A total of 1,175 pregnant women with high risk of ABO-HDN, accounting for 31.10% of the total, were found in 3 777 O-pregnant women with serum Ig G anti-A anti-B titer. There were 2 602 low-risk pregnant women (68.90%). Among them, 769 high-risk pregnant women were followed up with newborns with pregnancy outcome. The blood type of the fetus was 641 corresponding to the anti-A or anti-B status of pregnant women, accounting for 83.36%. The non-corresponding 128 were 16.64%. The incidence of ABO-HDN in high-risk pregnant women, in which the neonatal blood type and antibody test corresponds, showed that the higher the antibody titer, the higher the incidence of ABO-HDN (χ2 trend = 23.752, P <0.01). Thirty randomly selected 30 pregnant women with serum Ig G anti-A titer ≥1: 256, extracted fetus free DNA from pregnant women’s peripheral blood plasma and detected fetal ABO blood group genotype by polymerase chain reaction-sequence specific primer typing , Consistent with the birth rate of 100% blood type. Conclusion The results of serum Ig G anti-A anti-B titer in pregnant women show the existence of interfering factors in ABO-HDN prenatal prophylaxis. However, the early diagnosis and treatment of ABO-HDN alone has some limitations. Diagnostic techniques as an adjuvant treatment Early diagnosis of ABO-HDN can effectively improve the level of diagnosis and treatment.