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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。
OBJECTIVE: To observe the titers of prenatal antibodies in maternal and non-pregnant women and to guide clinical medication in preventing neonatal hemolytic disease. Methods: A total of 259 cases of ABO blood group incompatibility were selected in both couples. The antibody titers were detected dynamically during the first 16 weeks of pregnancy. Antibody titers ≤1: 32 were normal, and only dynamic observation and no intervention were performed. For antibody titers≥1: 64, given during pregnancy drug treatment, while continuing to monitor antibody titer. Follow-up observation after childbirth all newborns jaundice degree and outcome. Results: There were 259 cases of ABO blood group incompatibility between the two couples. 195 cases (75.29%) had serum antibody titers = 1:32 for the first time, 64 cases (≥1: 64) accounted for 24.71% 36 cases, accounting for 56.25%. In the process of dynamic monitoring, 4 new antibody titers ≥1: 64 were added, and the titers of the last antibody titers after 36 weeks gestation were taken as the statistical titers. There were 32 cases (≥1:64), accounting for 12.36% 17 cases were 1:64, 12 cases were 1:128, 3 cases were ≥1: 256. Neonatal hemolytic occurred in 8 cases, the incidence of 3.13%, 18 cases of pathological jaundice. Conclusion: The incidence of hemolytic disease in neonates is positively correlated with the antibody titers. However, patients with normal antibody titers during pregnancy may also develop disease. The onset time of newborns with antibody titers ≥1: 256 may also be delayed.