重度高胆红素血症患儿HDN血清学检查结果及相关因素分析~﹡
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摘要
目的探讨HDN血清学检查在重度高胆红素血症并行换血治疗患儿诊疗中的作用,为临床诊疗提供依据。方法对行换血治疗的重度高胆红素血症患儿标本进行ABO、Rh血型、溶血3项试验,产妇标本进行ABO血型、Rh血型、意外抗体筛查和抗体鉴定试验,分析HDN检查结果与血清总胆红素、日龄之间的关系。结果 372例标本中,共确诊ABO以外HDN 30例(8.06%)、ABO-HDN 172例(46.24%),非HDN 170例(45.70%),3组血清总胆红素及日龄差异均具有统计学意义(P<0.01);母婴血型O/A型与O/B型HDN检出率差异无统计学意义(P>0.05);HDN检出率随新生儿日龄增长呈下降趋势,其中日龄1—6 d呈快速下降趋势,6—9 d呈平稳趋势,9 d以上呈缓慢下降趋势;血清总胆红素随日龄增长呈先上升后下降趋势,于8.5 d达到峰值,约为518μmol/L。结论 HDN检查对重度高胆红素血症患儿病因的早期识别与诊断有较大临床意义,对重度高胆红素血症需换血治疗的患儿,不论是否错过最佳检查时机,仍应尽快检查。
Objective To detect the role of HDN serological test in newborns with severe hyperbilirubinemia in need of exchange transfusion, providing information for clinical diagnosis and treatment simultaneously. Methods ABO blood group, Rh blood group, and HDN hemolysis tests were conducted for the blood samples of newborns with severe hyperbilirubinemia in need of exchange transfusion. For maternal samples, identification of ABO blood group and Rh blood group, unexpected antibody screening and identification were conducted. We then analyzed the correlation between HDN test results and serum total bilirubin(TSB) as well as that between HDN test results and postnatal age in days, respectively. Results Among 372 cases, a total of 30 N-ABO-related HDN cases(8.06%), 172 ABO-related HDN cases(46.24%)and 170 non-HDN cases(45.70%)were confirmed. The TSB and age among the 3 groups were of statistically significant difference(P<0.01). Within ABO HDN groups, the incidents of HDN between group O mothers with group A infants and group O mothers with group B infants had no significant difference(P>0.05).The likelihood of HDN decreased with postnatal age, a rapid decline during 1—6 days first, then a steady trend persisting for 6—9 days, at last a slow decline on and after the 9 th day. Besides, TSB increased first and then decreased with age, reaching a peak of about 518 μmol/L at 8.5 days old. Conclusion HDN testing is of great clinical significance for the early identification and diagnosis of severe hyperbilirubinemia. For newborns with severe hyperbilirubinemia in need of exchange transfusion, the examination should be started as early as possible, even if the optimal time had been missed.
Objective To detect the role of HDN serological test in newborns with severe hyperbilirubinemia in need of exchange transfusion, providing information for clinical diagnosis and treatment simultaneously. Methods ABO blood group, Rh blood group, and HDN hemolysis tests were conducted for the blood samples of newborns with severe hyperbilirubinemia in need of exchange transfusion. For maternal samples, identification of ABO blood group and Rh blood group, unexpected antibody screening and identification were conducted. We then analyzed the correlation between HDN test results and serum total bilirubin(TSB) as well as that between HDN test results and postnatal age in days, respectively. Results Among 372 cases, a total of 30 N-ABO-related HDN cases(8.06%), 172 ABO-related HDN cases(46.24%)and 170 non-HDN cases(45.70%)were confirmed. The TSB and age among the 3 groups were of statistically significant difference(P<0.01). Within ABO HDN groups, the incidents of HDN between group O mothers with group A infants and group O mothers with group B infants had no significant difference(P>0.05).The likelihood of HDN decreased with postnatal age, a rapid decline during 1—6 days first, then a steady trend persisting for 6—9 days, at last a slow decline on and after the 9 th day. Besides, TSB increased first and then decreased with age, reaching a peak of about 518 μmol/L at 8.5 days old. Conclusion HDN testing is of great clinical significance for the early identification and diagnosis of severe hyperbilirubinemia. For newborns with severe hyperbilirubinemia in need of exchange transfusion, the examination should be started as early as possible, even if the optimal time had been missed.
引文
[1] 葛敏,唐军.新生儿重症高胆红素血症治疗进展.中华妇幼临床医学杂志(电子版),2018,14(3):360-367.
[2] Amin SB,Saluja S,Saili A,et al.Chronic auditory toxicity in late preterm and term infants with significant hyperbilirubinemia.Pediatrics,2017,140(4):e20164009.
[3] Keir AK,Stanworth S,Callum J.Innocent until proven guilty:do neonatal red blood cell transfusions really cause posttransfusion hyperbilirubinemia?Transfusion,2014,54(11):3014-3015.
[4] 中华医学会儿科学分会新生儿学组,中国新生儿胆红素脑病研究协作组.中国新生儿胆红素脑病的多中心流行病学调查研究.中华儿科杂志,2012,50(5):331-335.
[5] 叶姗,包蕾.足月儿重度高胆红素血症不良预后危险因素及评估方法.临床儿科杂志,2015,33(2):136-140.
[6] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识.中华儿科杂志,2014,52(10):745-748.
[7] 尚红,王毓三,申子瑜.全国临床检验操作规程,4版.北京:人民卫生出版社,2015:118-139.
[8] 彭小友,周杰英,李胜涛,等.换血治疗新生儿重度高胆红素血症142例临床分析.国际检验医学杂志,2017,38(21):2977-2981.
[9] 王婧,潘家华.母婴Rh血型不合溶血病的诊治进展.中国新生儿科杂志,2016,31(2):152-155.
[10] 赵倩,王振雷,何路军,等.Rh血型系统意外抗体致新生儿溶血病的实验室分析.河北医学,2018,24(2):283-286.
[11] 顾松,王亚娟,林影,等.MN与Rh系统新生儿溶血病的临床特点比较.中华围产医学杂志,2016,19(4):284-288.
[12] 韩雪芹,唐建军,夏斌.足月新生儿ABO溶血病伴高胆红素血症的临床分析.中华妇幼临床医学杂志(电子版),2016,12(2):154-158.
[2] Amin SB,Saluja S,Saili A,et al.Chronic auditory toxicity in late preterm and term infants with significant hyperbilirubinemia.Pediatrics,2017,140(4):e20164009.
[3] Keir AK,Stanworth S,Callum J.Innocent until proven guilty:do neonatal red blood cell transfusions really cause posttransfusion hyperbilirubinemia?Transfusion,2014,54(11):3014-3015.
[4] 中华医学会儿科学分会新生儿学组,中国新生儿胆红素脑病研究协作组.中国新生儿胆红素脑病的多中心流行病学调查研究.中华儿科杂志,2012,50(5):331-335.
[5] 叶姗,包蕾.足月儿重度高胆红素血症不良预后危险因素及评估方法.临床儿科杂志,2015,33(2):136-140.
[6] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识.中华儿科杂志,2014,52(10):745-748.
[7] 尚红,王毓三,申子瑜.全国临床检验操作规程,4版.北京:人民卫生出版社,2015:118-139.
[8] 彭小友,周杰英,李胜涛,等.换血治疗新生儿重度高胆红素血症142例临床分析.国际检验医学杂志,2017,38(21):2977-2981.
[9] 王婧,潘家华.母婴Rh血型不合溶血病的诊治进展.中国新生儿科杂志,2016,31(2):152-155.
[10] 赵倩,王振雷,何路军,等.Rh血型系统意外抗体致新生儿溶血病的实验室分析.河北医学,2018,24(2):283-286.
[11] 顾松,王亚娟,林影,等.MN与Rh系统新生儿溶血病的临床特点比较.中华围产医学杂志,2016,19(4):284-288.
[12] 韩雪芹,唐建军,夏斌.足月新生儿ABO溶血病伴高胆红素血症的临床分析.中华妇幼临床医学杂志(电子版),2016,12(2):154-158.