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目的探讨脐带血血清总胆红素检测在新生儿ABO溶血病(ABO-HDN)早期诊治中的意义,为早期筛查诊治新生儿溶血病提供参考。方法选择2013年3月-2016年2月浙江省台州医院482例母婴ABO血型不合新生儿为研究对象,进行ABO溶血三项试验,全自动生化分析仪测定脐带血血清总胆红素水平,分析脐带血血清总胆红素与HDN溶血三项不同试验结果、母亲血型、黄疸出现时间的相关性。结果 482例新生儿中ABO-HDN发生率为31.95%,其中母婴O-O型、O-A型、O-B型各占22.08%、46.75%、31.17%;77例发生高胆红素血症,HDN发生率、脐带血胆红素水平、抗体释放试验与游离抗体试验阳性率母婴O-A/B血型明显高于母婴O-O血型组(P<0.05),HDN发生率、脐带血胆红素水平在母婴O-A血型及母婴O-B血型间比较差异无统计学意义(P>0.05),抗体释放试验与游离抗体试验阳性率母婴O-A血型明显高于母婴O-B血型组(分别χ~2=5.265,P=0.021;χ~2=9.075,P=0.000),脐带血总胆红素在日龄≤3 d组明显高于日龄>3 d组,脐带血总胆红素水平DAT阳性患者明显高于DAT阴性患者(P<0.05),脐带血总胆红素水平在DAT阳性患者之间、DAT阴性患者之间比较差异无统计学意义(P>0.05),游离试验阳性与阴性之间比较差异无统计学意义;脐带血总胆红素水平越高,高胆红素血症发生率越高(r=0.741,P<0.05)。结论对于ABO血型不合新生儿脐带血血清总胆红素检测及溶血三项试验在早期诊治ABO-HDN方面有重要意义。
Objective To investigate the significance of cord blood serum total bilirubin detection in the early diagnosis and treatment of neonatal ABO hemolytic disease (ABO-HDN), and to provide a reference for the early screening diagnosis and treatment of neonatal hemolytic disease. Methods From March 2013 to February 2016, 482 neonates with unaccounted-for-abno-type ABO in maternal and neonates in Taizhou Hospital of Zhejiang Province were enrolled in this study. Three ABO hemolytic tests were performed. Total serum bilirubin level was measured by automatic biochemical analyzer. Analysis of cord blood serum total bilirubin and HDN hemolysis three different test results, maternal blood type, the correlation between the onset of jaundice. Results The incidence of ABO-HDN in 482 newborns was 31.95%, of which 22.08%, 46.75%, and 31.17% respectively. The incidence of hyperbilirubinemia and HDN in 77 infants , Umbilical cord blood bilirubin level, antibody release test and free antibody test positive rate of maternal OA / B blood group was significantly higher than that of mother-baby OO blood group (P <0.05), HDN incidence, cord blood bilirubin levels in maternal and child (P> 0.05). The positive rate of antibody release test and free antibody test in OA patients was significantly higher than that of maternal and infant OB blood groups (χ ~ 2 = 5.265, P = 0.021; χ ~ 2 = 9.075, P = 0.000). The total bilirubin in umbilical cord blood was obviously higher than that of day-old> 3 d in age ≤3 d group, and the positive rate of total bilirubin in umbilical cord blood was significantly higher DAT-negative patients (P <0.05), umbilical cord blood total bilirubin levels between DAT positive patients, DAT negative patients was no significant difference (P> 0.05), the positive and negative free test was no significant difference between Statistical significance; cord blood total bilirubin levels, the higher the incidence of hyperbilirubinemia (r = 0.741, P <0.05). Conclusions The three tests of serum total bilirubin and hemolysis in neonates with ABO-incompatible umbilical cord blood are of great significance in the early diagnosis and treatment of ABO-HDN.