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目的分析304例RhD阴性孕产妇RhD同种免疫发生情况,探讨RhD阴性孕产妇抗D抗体产生的影响因素,建立正确的围产期孕妇RhD新生儿溶血病监测方案。方法采用标准血清学方法对孕产妇及其丈夫进行ABO及RhD抗原鉴定。对RhD抗原鉴定为阴性的样本,进一步采用间接抗人球蛋白法检测RhD抗原,以排除或确认弱D型或部分D表型。对所有RhD阴性孕产妇及其丈夫进行RhCcEe表型的血清学分型。采用抗人球蛋白法对所有RhD阴性孕产妇标本进行不规则抗体初筛,对初筛阳性者进一步用鉴定细胞做抗体鉴定及抗体效价测定并采用PCR-SSP方法确定是否为Del型。结果 3975例孕产妇标本中,304例为RhD阴性,其中29例产生抗D抗体,夫妇ABO血型相合24例(82.76%),不合5例(17.24%)。本组调查中Rh阴性孕产妇抗D抗体产生的比例为9.54%(29/304)。经分子生物学方法鉴定,29例产生抗D的Rh阴性孕产妇均排除Del表型。结论 RhD阴性孕产妇RhD同种免疫的发生受多种因素影响,Del型孕产妇产生抗D概率较低。应及时、定期监测RhD阴性围产期孕妇的抗D水平。对已产生抗D抗体的孕妇,密切监测其抗D水平,为临床治疗方案提供依据。
Objective To analyze the occurrence of RhD alloimmunization in 304 RhD-negative pregnant women and explore the influencing factors of anti-D antibody production in RhD-negative pregnant women and to establish a correct monitoring program of RhD neonatal hemolytic disease in pregnant women of perinatal period. Methods Standard serological methods were used to identify the pregnant women and their husbands with ABO and RhD antigens. RhD antigen was identified as negative samples, and further detected by indirect anti-human globulin RhD antigen to exclude or confirm the weak D or partial D phenotype. Serological typing of the RhCcEe phenotype was performed on all RhD-negative pregnant women and their husbands. The anti-human globulin method was used to screen all RhD-negative pregnant women for irregular antibody. The positive cells were further identified by the identified cells and the antibody titer. The PCR-SSP method was used to determine whether the antibody was Del-type. Results Of the 3975 pregnant women, 304 were RhD-negative, of which 29 were anti-D antibodies. The ABO blood group coincidence was found in 24 (82.76%) and 5 (17.24%) cases. In our study, the proportion of Rh-negative maternal anti-D antibodies was 9.54% (29/304). The molecular biological methods identified 29 cases of anti-D Rh-negative pregnant women are excluded Del phenotype. Conclusion RhD-negative pregnant women with RhD alloimmune affected by many factors, Del-type pregnant women have a lower probability of anti-D. Anti-D level of pregnant women with RhD-negative perinatal period should be monitored regularly and regularly. For pregnant women who have developed anti-D antibodies, their anti-D levels are closely monitored to provide the basis for clinical treatment.