未行被动免疫治疗已致敏的RhD阴性血型孕妇围产儿结局分析

摘要

目的:探讨未行被动免疫治疗已致敏的RhD阴性血型孕妇所娩的新生儿的围产情况.方法:选择2012年1月至2017年3月四川大学华西第二医院收治的83例未行被动免疫治疗已致敏 (即抗D抗体阳性) RhD阴性血型孕妇为研究对象, 收集其相应临床资料, 采取回顾性分析法对不同抗D抗体滴度、不同孕产史及ABO血型是否相合的新生儿围产情况进行分析.结果:①42例 (50.60％) 孕妇所娩新生儿发生Rh溶血病 (Rh-HDN), 15例 (18.07％) 新生儿因Rh-HDN病情严重行换血治疗;83例孕妇分娩前抗D抗体滴度与Rh-HDN发生率、新生儿输血率、新生儿换血治疗率呈正相关 (r=0.499, P＜0.001;r=0.574;P＜0.001;r=0.432, P＜0.01), 抗D抗体滴度≥1:128者新生儿Rh-HDN发生率为100.00％ (30/30), 抗D抗体滴度≥1:512时新生儿因严重Rh-HDN换血治疗率高达61.54％ (8/13);②在初次妊娠、仅有流产史、有生产史孕妇中分娩新生儿Rh-HDN发生率比较, 差异有统计学意义 (P＜0.001), 但新生儿行换血治疗率差异无统计学意义 (P＞0.05);③83例孕妇新生儿Rh-HDN发生率、新生儿换血治疗率在合并母婴ABO血型相合与不相合中差异无统计学意义 (P＞0.05) .结论:未行被动免疫已致敏Rh阴性孕妇所娩新生儿Rh-HDN的发生及病情严重程度与孕期母体抗D抗体滴度、母体孕产史等密切有关, 孕期监测抗体滴度及严密监护胎儿情况, 有助于降低新生儿病率及死亡率, 改善其围产结局.%Objective:To explore the perinatal condition of neonates delivered by sensitized pregnant women with RhD-negative blood type without passive immunotherapy.Methods:83 cases of sensitized pregnant women with RhD-negative blood group without passive immunotherapy were enrolled from January 2012 to March 2017 in West China Second University Hospital, Sichuan University.The corresponding clinical data were collected.Retrospective analysis was performed to analyze the perinatal condition of newborns delivered by women with different anti-D antibody titers, different pregnancy histories and ABO blood groups.Results:①Rh hemolytic disease (Rh-HDN) occurred in 42 cases (50.6％) pregnant women.In 15 cases (18.07％), the neonates were treated with exchange transfusion for severe neonatal Rh-HDN.The anti-D antibody titer before delivery was positively correlated with the occurrence of Rh-HDN, neonatal blood transfusion, and neonatal exchange transfusion rate in all 83 cases (r=0.499, P＜0.001;r=0.574, P＜0.001;r=0.432, P＜0.01).The incidence of Rh-HDN in neonates with maternal anti-D antibody titer ≥1:128 was 100％.The rate of exchange transfusion therapy for severe Rh-HDN in neonatal was as high as 61.54％ (8/13) when maternal anti-D antibody titer≥1:512.②There was a significant difference in the incidence of Rh-HDN in neonates delivered by pregnant women with different pregnancy histories (P＜0.001).However, there was no significant difference in the rate of neonatal transfusion therapy (P＞0.05).③Among 83 pregnant women, the incidence of neonatal Rh-HDN and the rate of blood exchange transfusion treatment between "compatible" and "incompatible" ABO blood group were not significantly different (P＞0.05).Conclusions:The incidence and severity of neonatal Rh-HDN are closely related to the maternal antibody titer during pregnancy and maternal pregnancyhistories in sensitized Rh-negative pregnant women without passive immunotherapy.Antibody titer detection during pregnancy and close monitoring of the fetus could help to reduce the neonatal morbidity and mortality, improve the pregnancy outcomes.