3 463例O型血孕婦產(chǎn)前IgG抗A(B)抗體效價分析*

屈琳，劉鳳霞

(中南大學湘雅三醫(yī)院a.檢驗科，b.輸血科，長沙 410013)

·臨床實驗研究·

3 463例O型血孕婦產(chǎn)前IgG抗A(B)抗體效價分析*

屈琳a，劉鳳霞b

(中南大學湘雅三醫(yī)院a.檢驗科，b.輸血科，長沙 410013)

目的探討微柱凝膠法檢測IgG抗A(B)抗體效價的臨界值，分析抗體效價水平變化和孕婦年齡與新生兒溶血病發(fā)生率的關(guān)系。方法根據(jù)圍產(chǎn)期3 463例孕婦及其丈夫血型，分別用微柱凝膠法和試管法檢測IgG抗A、抗B抗體效價。根據(jù)不同妊娠次數(shù)(1次、2次、≥3次)，將1 620例O型孕婦分3組，從22周開始每隔 4 周檢測血清中IgG抗 A(B)的效價，分別用微柱凝膠法檢測IgG抗A、抗B抗體效價，檢測新生兒溶血病相關(guān)指標。結(jié)果微柱凝膠法抗體效價256作為參考值；3 463例圍產(chǎn)期孕婦檢測IgG抗A(B)，IgG抗A檢測共2 257人次，其幾何平均效價為169，IgG抗B檢測共1 711人次，其幾何平均效價為143。連續(xù)監(jiān)測1 620例不同孕次數(shù)O型血孕婦，首次妊娠896例中IgG抗A(B)抗體效價≥256的共260例(29.02%)，2次妊娠248例IgG抗A(B)抗體效價≥256的共107例(43.15%)，≥3次妊娠共476例IgG抗A(B)抗體效價≥256的共220例(46.70%)；抗體效價滴度分別升高1、2、3個及以上孕婦的平均年齡分別為26.4、27.8、29.9歲，新生兒溶血病的發(fā)生率分別為21.66%、40.94%、84.90%。結(jié)論檢測O型孕婦產(chǎn)前血清中IgG抗體時，微柱凝膠法的敏感性高于傳統(tǒng)試管法，微柱凝膠法檢測抗體效價的參考值高于試管法；多次妊娠者IgG抗A(B)抗體效價陽性率高于首次妊娠者；且當抗體效價升高2個及以上滴度時，年齡越高，HDN發(fā)病率越高。

IgG抗A(B)抗體；抗體效價；連續(xù)監(jiān)測；新生兒溶血病

Abstract:ObjectiveTo investigate the threshold of IgG anti-A (B)antibody with microcolumn gel method and analyze the correlations between the incidence of neonatal hemolytic disease and IgG antibody titer in pregnant women as well as their age for the guidance of prenatal early prevention.MethodsBased on blood type of 3 463 perinatal pregnant women and their husbands, the titers of prenatal antibody IgG against A and B were determined by both microcolumn gel and test tube method. The 1 620 pregnant women with blood type O were divided into three groups according to different pregnancy times (1, 2, 3 or more than 3 times). The titers of serum IgG anti A and B were determined every 4 weeks from the 22th week using micro column gel method. The newborn hemolytic disease-related indicators were detected simultaneously.ResultsIn this laboratory, 256 of the antibody titer by microcolumn gel method was used as the indoor reference value. The geometric average titer of IgG anti-A was 169 in 2 257 person-times of perinatal women, and the titer of IgG anti-B was 143 in 1 711 person-times of perinatal women. The 1 620 women with blood type O were continuous monitored at different pregnant times. In 896 women with first pregnancy, 260 cases (29.02%)showed 256 or more than 256 of IgG anti A (B)antibody titer, 107 cases (43.15%)in 248 women with the second pregnancy showed 256 or more of IgG anti A (B)antibody titer, and 220 cases (46.70%)in 476 women with the third pregnancy or more showed 256 or more of IgG anti A (B)antibody titer. The average ages of the pregnant women with increased 1, 2 and 3 antibody titers were 26.4, 27.8 and 29.9 respectively, and the incidences of hemolytic disease of newborn (HDN)were 21.66%, 40.94% and 84.90% respectively.ConclusionIn detecting IgG antibody in prenatal serum of pregnant women with O type, the sensitivity of microcolumn gel method for IgG antibody should be obviously higher than that of the traditional test tube method. The reference value of microcolumn gel method or IgG antibody titer was obviously higher than that of test tube method. The positive rate of IgG anti-A antibody in multiple pregnancies was significantly higher than that in the first pregnancy. The incidence of HDN may increase with the age of pregnant women when the titer of IgG antibody increased by 2 or more titers.

Keywords: IgG-A (B)antibody; antibody titer; dynamic monitoring；hemolytic disease of newborn

新生兒溶血病(hemolytic disease of the newborn，HDN)是指母胎血型不合所致的胎兒或新生兒免疫性溶血性疾病。我國以ABO血型不合者占多數(shù)[1]。……