Rh(D)阴性经产妇应用抗-D免疫球蛋白预防胎儿及新生儿溶血病疗效观察

Use of anti-D immunoglobulin during pregnancy for prevention of hemolytic disease in fetus and newborn

  • 摘要: 目的 分析应用抗D免疫球蛋白预防新生儿Rh溶血病的临床价值。方法 纳入2010年1月1日-2017年12月31日重庆医科大学附属第一医院、内江市第一人民医院、四川大学华西第二附属医院/华西妇女儿童医院的104例Rh(D)阴性经产妇,根据其是否注射抗-D免疫球蛋白分为anti-D Ig组和对照组,比较两组孕产妇抗-D抗体产生人数、发生新生儿溶血症人数、早产人数、新生儿转入重症监护室人数、出生体质量、经皮胆红素等妊娠结局的差异。结果 在104例Rh(D)阴性经产妇中,注射抗D免疫球蛋白组(anti-D Ig组,n=51)的Rh(D)阴性经产妇产生抗体3例,占5.88%(3/51),而未注射抗D免疫球蛋白组(对照组,n=53)经产妇产生抗体14例,占26.42%(14/53),两组差异有统计学意义(P<0.01)。两组新生儿经皮胆红素水平,anti-D Ig组为(9.53±2.32) mg/dl,对照组为(12.62±4.82) mg/dl,差异有统计学意义(P<0.05)。新生儿转入重症监护室比例,anti-D Ig组为7.84%(4/51),对照组为32.08%(17/53),差异有统计学意义(P<0.01)。早产率anti-D Ig组为1.96%(1/51),显著低于对照组的13.20%(7/53)(P<0.01)。两组新生儿性别、出生孕周、出生体质量、Apgar评分和输血治疗方面,差异无统计学意义(P均>0.05)。结论 Rh(D)阴性孕产妇注射抗-D免疫球蛋白可明显降低抗-D抗体产生率,降低新生儿发生高胆红素血症、早产率和转入重症监护室人数。

     

    Abstract: Objective To analyze the value of anti-D immunoglobulin in the prevention of hemolytic disease in fetus and newborn. Methods From January 1,2010 to December 31,2017,104 Rh (D)-negative parturients admitted to the First Affiliated Hospital of Chongqing Medical University,the First People's Hospital of Neijiang City or West China Second Affiliated Hospital,Sichuan University/West China Women and Children's Hospital were included in this study.They were divided into anti-D immunoglobulin group (n=51) and control group (n=53) according to whether they were injected with anti-D immunoglobulin or not.The differences in pregnancy outcomes between the two groups were compared,including the production rate of anti-D antibody,the incidence of neonatal hemolysis,the premature delivery rate,the admission rate of neonatal intensive care unit,birth weight,transcutaneous bilirubin level and so on. Results Of the 104 Rh (D)-negative parturients,3 cases (5.88%,3/51) produced antibodies in the anti-D immunoglobulin group,while 14 cases (26.42%,14/53) produced antibodies in control group,and the difference was statistically significant (P=0.01).The level of transcutaneous bilirubin was 9.53±2.32 mg/dl in the anti-D immunoglobulin,significantly lower than 12.62±4.82 mg/dl in the control group (P=0.04).The incidences of neonates transferred to neonatal intensive care unit (7.84%4/51 vs 32.08%17/53),and premature delivery (1.96%1/51 vs 13.20%7/53) in the anti-D immunoglobulin group were significantly higher than those in the control group (P<0.05,respectively).There was no significant difference in neonatal sex,gestational age,birth weight,Apgar score and blood transfusion treatment between the two groups (P>0.05). Conclusion The results show that anti-D immunoglobulin decrease the production rate of anti-D antibody,the incidence of hyperbilirubinemia in neonates,the premature delivery and the rate of neonates transferred to NICU in Rh (D)-negative pregnant women.

     

/

返回文章
返回