【摘要】：目的:探討Rh陰性孕婦產(chǎn)前免疫血液學檢查和結局分析。方法:回顧性分析2010年1月至2016年12月期間在我院孕檢及分娩的22880例孕婦中有Rh陰性孕婦287例(1.25%),用血清學方法確認血型D抗原陰性、Rh系統(tǒng)其他抗原表現(xiàn)型及抗體篩選;對有抗-D抗體孕婦進一步做抗體效價及分娩后根據(jù)新生兒黃疸指數(shù)做新生兒溶血病檢測。部分Rh陰性孕婦于孕37周做預存式自體備血。結果:Rh陰性孕婦287例中,有12例(4.18%)檢出抗-D抗體,抗原表現(xiàn)型均為ccee,且均有完整生育史。90例有1胎生育史中檢出抗-D抗體10例(11.11%),15例有2胎生育史中檢出抗-D抗體2例(13.33%)。287例孕婦生育290個新生兒中有8個發(fā)生胎兒新生兒Rh溶血病,發(fā)生率占2.75%(8/290)。12例抗-D抗體孕婦中1例宮內(nèi)有溶血,出生后治療無效死亡,7例出生后發(fā)現(xiàn)新生兒黃疸,經(jīng)換血等治療后治愈,其余4例新生兒無黃疸出現(xiàn)。146例Rh陰性孕婦孕37周實施了預存式自體備血,剖宮產(chǎn)與經(jīng)陰道分娩產(chǎn)婦比較自體備血與未自體備血者產(chǎn)后出血量,顯示兩組差異均無統(tǒng)計學意義(P0.05)。結論:有完整生育史且抗原表現(xiàn)型為"ccee"Rh陰性孕婦發(fā)生抗-D同種免疫反應可能會加大,但新生兒結局差異很大;Rh陰性孕婦分娩前可根據(jù)自身狀況做預存式自體備血。
[Abstract]:Objective: to investigate the prenatal immunological examination and outcome analysis of Rh negative pregnant women. Methods: from January 2010 to December 2016, 287 cases (1.25%) of 22880 pregnant women with Rh negative in pregnancy and delivery in our hospital were analyzed retrospectively. Other antigen phenotypes and antibody screening of Rh system were confirmed by serological method. The antibody titers of pregnant women with anti-D antibody and neonatal hemolytic disease were determined according to neonatal jaundice index after delivery. Some Rh-negative pregnant women received pre-stored autologous blood at 37 weeks of gestation. Results Anti-D antibody was detected in 12 of 287 cases (4.18%) of 287 pregnant women with negative Rh. The antigenic phenotypes were ccee.There were 10 cases (11.11%) of anti-D antibody detected in 10 cases (11.11%) and 2 cases (13.33%) of 2 cases of anti-D antibody in all the 90 cases with complete fertility history and 8 cases of Rh hemolytic disease in 8 out of 290 newborns of 287 pregnant women, among which 10 cases (11.11%) had anti-D antibody in 15 cases (11.11%) and 2 cases (13.33%) had anti-D antibody in 2 cases (13.33%) of 287 newborns. The incidence rate was 2.75% (8 / 290). One of 12 pregnant women with anti-D antibody had intrauterine hemolysis. The remaining 4 newborns without jaundice. 146 cases of Rh negative pregnant women performed preexisting autologous blood reserve at 37 weeks of pregnancy. The volume of postpartum hemorrhage in cesarean section and vaginal delivery was higher than that in vaginal delivery. There was no significant difference between the two groups (P0.05). Conclusion: the anti-D alloimmune reaction may increase in pregnant women with a complete reproductive history and antigen phenotype "ccee" Rh negative, but the neonatal outcome of Rh negative pregnant women may be pre-stored autologous blood reserve according to their own condition before delivery.
【作者單位】： 上海交通大學附屬上海市第六人民醫(yī)院;
【分類號】：R714

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