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临床输血与检验

临床输血与检验 ›› 2025, Vol. 27 ›› Issue (1): 64-69.DOI: 10.3969/j.issn.1671-2587.2025.01.009

• 临床输血 • 上一篇    下一篇

1 131例ABO系统胎儿新生儿溶血病胆红素水平及血清学检测结果影响因素分析*

陈婷婷, 胡文静, 黄蓉   

  1. 南京医科大学附属妇产医院（南京市妇幼保健院）输血科,江苏南京 210001
  • 收稿日期:2024-07-26 发布日期:2025-02-25
  • 通讯作者: 黄蓉,主要从事临床输血工作,（E-mail）huangrong@njmu.edu.cn。
  • 作者简介:陈婷婷,主要从事临床输血工作,（E-mail）623770913@qq.com。
  • 基金资助:
    *本课题受江苏省输血协会英科新创科研基金（No.JSYK2023002）资助

Analysis of Factors Affecting Bilirubin Levels and Serological Test Results in 1 131 Cases of ABO System Hemolytic Disease of the Fetus and Newborn

CHEN Tingting, HU Wenjing, HUANG Rong   

  1. Department of Medical Laboratory, Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital. Nanjing 210001
  • Received:2024-07-26 Published:2025-02-25

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摘要： 目的 通过对南京市妇幼保健院ABO胎儿新生儿溶血病（hemolytic disease of the fetus and newborn,HDFN）发生情况进行回顾性调查分析,探讨ABO-HDFN患儿胆红素水平及血清学检测结果影响因素。方法 选取2022年1月─2023年12月收治的1 131例确诊为ABO-HDFN患儿作为研究对象,检测其血清总胆红素（total bilirubin, TBIL）、间接胆红素（indirect bilirubin, IBIL）、血红蛋白（hemoglobin, Hb）和碳氧血红蛋白（carboxyhemoglobin, COHb）水平,同时进行溶血三项血清学检测,并收集患儿体重、胎龄、就诊日龄等临床资料,分析患儿胆红素水平、溶血发生及其严重程度影响因素。结果 1 131例确诊为ABO溶血的患儿中,胎龄39.14（38,40.14）周,体重3 240（2 890,3 540）克。TBIL和IBIL水平在出生体重、是否多胎、胎龄、分娩方式、喂养方式和就诊日龄方面差异有统计学意义（P<0.05）; TBIL和IBIL水平在性别、血型和胎次方面差异无统计学意义（P>0.05）。三项血清学检测中直接抗球蛋白试验（direct antiglobulin test, DAT）阳性率19.36%（219/1 131）,游离抗体试验阳性率84.08%（951/1 131）,放散试验阳性率100%;将三项血清学结果分为“三项阳性”、“两项阳性”和“一项阳性”三组,患儿TBIL、IBIL、Hb和COHb水平在不同分组中差异有统计学意义（P<0.05）。日龄≤3 d患儿DAT、游离抗体试验的阳性率最高,分别为29.22%（161/551）、90.74%（500/551）,日龄4~7 d患儿DAT、游离抗体试验的阳性率分别为11.31%（57/504）、79.96%（403/504）, 日龄≥8 d患儿DAT、游离抗体试验的阳性率分别为1.32%（1/76）、63.1%（48/76）。随着日龄的增加,患儿直抗、游离的阳性率也随之降低（P<0.001）。结论 ABO-HDFN严重程度跟血清学三项试验、Hb和COHb有关;针对母婴ABO血型不合的患儿,应及时进行胆红素水平和三项血清学检测,对ABO-HDFN的预防和治疗有重要意义。

关键词: 胆红素水平, ABO胎儿新生儿溶血病, 血清学检测, 就诊日龄

Abstract: Objective This study retrospectively investigates and analyzes the occurrence of ABO hemolytic disease of the fetus and newborn (ABO-HDFN) at Nanjing Maternal and Child Health Hospital. It aims to explore the factors influencing bilirubin levels and serological test results in children diagnosed with ABO-HDFN. Methods A total of 1 131 children diagnosed with ABO-HDFN between January 2022 and December 2023 were selected for analysis. Serum total bilirubin (TBIL), indirect bilirubin (IBIL), hemoglobin (Hb), and carboxyhemoglobin (COHb) levels were measured. Additionally, three serological tests for hemolysis were performed. Clinical data, including birth weight, gestational age, and neonatal age, were collected to analyze the factors influencing bilirubin levels, the incidence of hemolysis, and its severity. Results Among the 1 131 children diagnosed with ABO hemolysis, the median gestational age was 39.14 (38, 40.14) weeks, and the median birth weight was 3 240 (2 890, 3 540) grams. Significant differences in TBIL and IBIL levels were observed in relation to birth weight, multiple births, gestational age, mode of delivery, feeding method, and neonatal age (P<0.05). However, there were no significant differences in TBIL and IBIL levels based on gender, blood type, or gravida (P>0.05). The direct antiglobulin test (DAT) had a positive rate of 19.36% (219/1 131), the free antibody test had a positive rate of 84.08% (951/1 131), and the release test had a positive rate of 100%. Based on the serological test results, the children were categorized into "three positives," "two positives," and "one positive" groups, with significant differences in TBIL, IBIL, Hb, and COHb levels among these groups (P<0.05). The highest positive rates for DAT and the free antibody test were observed in children aged≤3 days, at 29.22% (161/551) and 90.74% (500/551), respectively. In children aged 4-7 days, the positive rates were 11.31% (57/504) and 79.96% (403/504), respectively, while in children aged ≥8 days, the rates were 1.32% (1/76) and 63.1% (48/76), respectively. As neonatal age increased, the positive rates for DAT and the free antibody test significantly decreased (P<0.001). Conclusion The severity of ABO-HDFN is associated with the results of the three serological tests, as well as Hb and COHb levels. For children with maternal-infant ABO blood type incompatibility, timely monitoring of bilirubin levels and performing the three serological tests are crucial for the prevention and management of ABO-HDFN.

Key words: Bilirubin levels, ABO-Hemolytic disease of the fetus and newborn, Serological test, Neonatal age

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