O型孕妇产前IgG血型抗体效价与新生儿溶血病的相关性

目的:探讨O型孕妇产前IgG血型抗体效价与新生儿溶血病(HDN)的相关性。方法:选择2013年1月至2015年12月期间,在我院分娩的夫妻ABO血型不合的O型Rh(D)阳性孕妇432例及新生儿为研究对象,观察孕妇血清IgG抗体效价情况,新生儿HDN发病情况,并分析二者相关性。结果:432例孕妇中血清IgG抗A(B)效价大于或等于1:64的有189例,占43.75%,随IgG抗A(B)效价升高,孕妇比例逐渐减少。随孕次增加,孕妇血清IgG抗A(B)效价逐渐增高,各组孕妇血清IgG抗A(B)效价比较有统计学差异(P0.05)。随年龄增加,孕妇血清IgG抗A(B)效价逐渐增高,各组孕妇血清IgG抗A(B)效价比较有统计学差异(P0.05)。随IgG抗A(B)效价升高,HDN发生率显著升高,各组比较有统计学差异(P0.05)。等级相关检验显示,孕妇血清IgG抗A(B)与HDN发生呈正相关(r=0.732,P0.05)。结论:O型孕妇产前IgG血型抗体是引起HDN的主要原因,其水平与HDN呈正相关,值得临床重视。     

O型血产妇新生儿溶血病的发生情况及影响因素分析

目的:探讨O型血孕妇新生儿溶血病(HDN)的发生情况及影响因素。方法:选择2013年6月~2016年12月在海南省人民医院行产前检查的140例O型血孕妇,进行产前血型抗体效价检测,比较丈夫ABO血型、产前IgG抗-A(B)效价及新生儿性别与HDN的发生情况。结果:O型血孕妇产后HDN的总发生率为37.9%。丈夫不同ABO血型、男性和女性新生儿HDN的发生率比较差异均无统计学意义(P0.05)。产前IgG抗-A(B)效价≤32、64、128、256和≥512组HDN的发生率分别为9%、27%、60%、75%、90%,组间比较差异均有统计学意义(P0.05),且随着抗体效价的增加,HDN的发生率逐渐升高。结论:O型血孕妇HDN的发生率较高,与丈夫ABO血型和新生儿性别均无关,与孕妇产前血清IgG抗-A(B)效价有关,随抗体效价增高而升高。     

茵陈蒿汤联合西药治疗母儿ABO血型不合疗效分析

目的：评价中西药结合治疗对母儿ABO血型不合的疗效以及新生儿溶血发生与孕次关系的探讨。方法：对314例抗体滴度≥l：64的ABO母儿血型不合孕妇（20-45岁）进行研究,其中246例孕期给予以中西药结合治疗（茵陈蒿汤联合25%葡萄糖液、维生素C、维生素E、苯巴比妥）,68例作为对照,观察孕妇IgG抗A/B抗体效价变化及新生儿溶血发生情况。结果：治疗组抗体效价降低与对照组相比,差异有统计学意义（P〈0.05）,治疗组新生儿溶血发生率与对照组相比,差异有统计学意义（P〈0.05）。孕次越大,新生儿溶血的发生率越高。结论：中西药结合治疗对降低孕妇IgG抗A/B效价及防治新生儿溶血疗效满意,新生儿溶血发生可能与孕次呈正相关。     

1939例ABO血型系统新生儿溶血病的血型分布

目的：探讨在母婴ABO血型不合引起的新生儿溶血病（HDN）中的血型分布。方法：对临床表现怀疑为HDN的1939例新生儿进行血清学试验检测,包括新生儿红细胞直接抗人球蛋白试验,红细胞抗体释放试验和游离抗体试验,同时检测母亲ABO血型和RhD血型。结果：1939例婴儿母亲血型均为O型RhD阳性。A型血新生儿818例,其中直接抗人球蛋白试验阳性率17.2%（141/818）,红细胞抗体释放试验阳性率89.2%（730/818）。B型血婴儿1121例,其中直接抗人球蛋白试验阳性率10.9%（121/1121）,红细胞抗体释放试验阳性率78.6%（881/1121）。结论：ABO血型不合引起的HDN中,A型新生儿比B型新生儿患病几率更大。     

O型孕妇ABO同种异体免疫型IG抗体效价的分析

目的:检测O型孕妇血清ABO同种异体免疫型IG抗体效价.方法:将1204例O型孕早期孕妇按照其夫的血型分为四组,即O-A、O-B、O-AB-A、O-AB-B,用微柱凝胶法抗人球蛋白试验分别测定抗体效价;同时从中随机选择304例抗体效价≤ 1:64的孕妇定期检测.结果:在O-A、O-B组中及O-AB组中抗A及抗BIgG抗体效价>64的病例分别占29.88%,19.92%,20.00%及18.18%,各血型组合均有发生新生儿溶血病的可能性,差异无显著性(P>0.05);部分抗体效价低于1:64的孕妇在孕后期效价上升,与孕早期比较差别有统计学意义(t=2.271,P<0.05),且随孕周增大而上升(r=0.979,t=8.293,P<0.05).结论:常规对孕妇血清血型抗体IgG效价进行检测有助于有助于诊断新生儿溶血病(hemolytic disease of the newborn,HDN),指导临床干预措施,尤其应该注重低抗体效价孕妇的定期检测.     

Rh血型系统在输血中的作用

Rh血型与输血是一个值得重视的临床问题,Rh血型不合可引起溶血性输血反应和新生儿溶血病(HDN),输血前常规检测Rh血型,应用聚合酶链反应-序列特异性引物扩增(PCR-RRP)技术检测rhd基因型,具有重要的临床意义。PCR-RHD基因定型技术应用于HDN的产前诊断,可预防新生儿溶血病的发生。     

不同放散试验对新生儿ABO溶血病的诊断价值对比

摘要 目的：分析与比较不同放散试验对新生儿ABO溶血病的诊断价值。方法：选择2017年9月至2019年6月在本院进行ABO溶血病检测的新生儿240例,取所有新生儿的静脉血样本2~3 mL,采用冷冻复融放散试验方法与改良热放散试验方法检测新生儿ABO溶血病的发生情况,并比较单独诊断和联合诊断的价值。结果：在240份标本中,冷冻复融放散试验检出新生儿ABO溶血病阳性130例,阳性检出率为54.2 %;改良热放散试验检出新生儿ABO溶血病阳性94例,阳性检出率为39.2 %;二者联合检出新生儿ABO溶血病阳性100例,阳性检出率为41.67 %,联合检出新生儿ABO溶血病阳性率和冷冻复融放散试验检出新生儿ABO溶血病阳性率显著高于改良热放散试验检出新生儿ABO溶血病阳性率(P<0.05)。临床最终诊断为新生儿ABO溶血病101例,阳性率为42.08 %,患儿ABO血型包括A型56例,B型45例。冷冻复融放散试验诊断新生儿ABO溶血病的敏感性和特异性为73.8 %和95.5 % ,ROC曲线面积0.775;改良热放散试验检诊断为新生儿ABO溶血病的敏感性和特异性为100 %和95.2 %,ROC曲线面积0.853;二者联合诊断对新生儿ABO溶血病的敏感性和特异性为90.0 %和97.85 %,ROC曲线面积0.872,联合诊断特异性优于改良热放散试验检诊和冷冻复融放散试验诊断,且改良热放散试验检诊敏感性优于冷冻复融放散试验诊断。结论：相对于冷冻复融放散试验,改良热放散试验对新生儿ABO溶血病的诊断敏感性更高,且不影响诊断特异性,两种放散方法联合检测具有更好的应用价值。     

90例新生儿ABO溶血三项试验检测结果分析

分析新生儿ABO溶血三项实验检测结果,探讨溶血三项实验在诊断新生儿溶血病,特别是ABO溶血病(ABO-HDN)中的诊断价值。新生儿ABO-HDN多见于母体O型,新生儿A或B型者,溶血三项实验诊断ABO-HDN符合疾病诊断需要,结合血液生化指标、血常规,可快速明确诊断。     

非洲人的ABO血型分布

ABO血型分布在国内已有不少报告,但非洲黑种人的ABO血型分布尚未见报道。笔者参加援外医疗队,在非洲西部冈比亚班桑医院工作期间,对住院的黑人病人及其献血员(含病人家属)进行了ABO血型检查,其中男性1965人,女性1413人。所用标准血清一部分是自制,一部分是英国制造,抗A和抗B血清效价均     

静脉输注丙种球蛋白与新生儿溶血病患儿坏死性小肠结肠炎发生的关系

目的探讨静脉输注丙种球蛋白(IVIG)与新生儿溶血病(HDN)患儿坏死性小肠结肠炎(NEC)发生的关系。方法收集重庆医科大学附属儿童医院2013年1月1日至2014年1月1日确诊为HDN患儿的临床资料,采用倾向评分配比法建立回顾性队列研究,根据是否使用IVIG分为IVIG组和非IVIG组,比较两组患儿NEC发生情况。进一步以配比后病例建立病例对照研究,探讨溶血病患儿发生NEC的危险因素。结果共1 217例HDN患儿纳入研究,其中40例合并NEC,309例进行IVIG。进行1∶2的倾向评分配比后,共有199对匹配成功,其中NEC组25例,非NEC组572例。结果显示,倾向评分配比后,IVIG治疗并未增加溶血病患儿NEC的发生率,4.5%(9/199)vs 4.0%(16/398),χ2=0.083,P=0.773。单因素分析显示,早产、低出生体重、多胎、胎膜早破、产前糖皮质激素、静脉营养、先天性心脏病、最高胆红素值与溶血病患儿发生NEC有关。二元Logistic回归显示,先天性心脏病是溶血病患儿发生NEC的独立危险因素(OR:4.021,95%CI:1.286~12.578)。结论 IVIG治疗不增加溶血病患儿发生NEC的概率,合并先天性心脏病的HDN患儿更易发生NEC。     

Immunogenetic studies of maternal-fetal relationships: a review: why newborn rhesus monkeys don't get hemolytic disease

The discovery of the Rh blood group factor in humans was made using the red blood cells of rhesus monkeys. Because of its importance to human medicine and immunogenetics, this finding contributed greatly to the appreciation of the importance of nonhuman primates in research. It is now widely recognized that blood group incompatibility between mother and fetus can lead to differential fertility, fetal death, and hemolytic disease of the newborn (HDN).The blood group systems of several nonhuman primate species have been studied in detail and found to be analogous, although not identical, to those of humans. It is therefore surprising that HDN has been reported in only four nonhuman primate species-marmosets, sacred baboons, chimpanzees, and orangutans. Maternal-fetal blood group incompatibility and its consequences have been extensively studied in rhesus monkeys, and these macaques may well be representative of many nonhuman primates. Rhesus monkeys exhibit all five of the conditions that lead to HDN in humans: (1) blood group incompatible matings: (2) transplacental hemorrhage: (3) maternal immunization to blood group alloantigens on fetal erythrocytes: (4) transplacental transfer of maternal antibodies; and (5) coating of the newborn's erythrocytes. Yet, newborns show no clinical or hematological evidence of HDN.We have shown that the rhesus alloantibodies engendered by transplacental immunization do not mediate immune elimination of the newborn's erythrocytes. Evaluation of the maternal antibodies demonstrated that they have low titers and low avidities and perhaps belong to IgG subclasses that do not bind effectively to receptors on phagocytic cells of the rhesus reticuloendothelial system. The newborn's genotype may also affect the expression of allogeneic blood group antigens and thereby help protect the newborn's cells from destruction. These factors together undoubtedly play a major role in the survival of the antibody-coated newborn's RBC and are thus able to account for the absence of HDN in this species.     

Distribution of blood antigens A, B, and D, in the population of Bogotá (Analysis of 30,000 samples)

As tested by anti-A and anti-B sera, blood drawn from 30,000 inhabitans of Bogotá, Colombia, showed the following phenotype percentages: A — 26.5, B — 8.0, AB — 1.1, and O — 64.4. The allele frequencies were: A — 0.150, B — 0.048, and O — 0.802. In the same samples anti-D (Rh₀) was used: 94.6% of the individuals carried the D antigen. All bloods were typed with fresh commercial sera. No back-typing was performed. Hemolytic disease of the newborn, caused by Rh-Hr isoimmunization, is more frequent (0.40%) in Bogotá than should be expected for a population having only (5.4%) or less “Rh negative” individuals. This paradoxical fact was observed in the analysis of 12,672 deliveries in an obstetrical hospital of Bogotá. A possible explanation could be the multiparity of Colombian women since the possibility of isoimmunization and hemolytic disease increases with each succeeding pregnancy in a given woman. Also it is well established that when Rh-Hr incompatibility is combined with ABO incompatibility, it is less apt to produce disease than when it occurs alone. AO isoimmunization should therefore be less frequent in Bogotá than in populations that have a higher frequency of A individuals. Thus, the women of Bogotá are less “protected” from Rh-Hr immunization by ABO incompatibility.     

免疫磁珠技术分离唾液A/B血型抗原并用于吸附血清A/B抗体

目的:应用免疫磁珠分离技术获得具有良好抗原性的A/B血型抗原,并探究其作为ABO血型抗体吸附剂去除A/B抗体的可行性。方法:将含有血型物质的唾液进行预处理,再与包被了抗体的磁珠混合,分离出纯度较高的A/B抗原,运用酶联免疫及凝集抑制试验验证所得抗原的抗原性及是否存在交叉反应。用未纯化A/B抗原和纯化A/B抗原包被磁珠,对含有抗A/B IgM、IgG的血清进行抗体吸附,用纯化A/B抗原对100份来自O型血孕妇的临床血清样本进行抗体吸附,分别评价其吸附效果。结果:纯化抗原与对应抗体反应后,其吸光度显著高于对照组(A抗原与A抗体0.85±0.12 vs.0.27±0.03,P0.01;B抗原与B抗体0.86±0.09 vs.0.24±0.06,P0.01),与其它类型抗体反应后的吸光度值与对照组比较差异无统计学意义(P0.05)。进行红细胞凝集抑制试验时,纯化抗原可显著抑制相应抗体与红细胞的凝集反应,对其它类型抗体与红细胞的凝集没有抑制作用。血清抗体吸附实验表明纯化抗原的吸附效率比未纯化抗原的高(97.00%vs.88.00%,P0.001)。临床样本抗体吸附实验显示,纯化A抗原对抗A IgM/IgG的吸附效率分别为96.88%、98.44%;纯化B抗原对抗B IgM/IgG的吸附效率分别为96.88%、98.44%。结论:磁珠纯化抗原能特异性地与对应抗体结合,有效吸附血清中的血型抗体,有望作为合成A/B抗原的替代品。     

应用改良流式法检测猕猴和食蟹猴体内血型抗体水平的分布情况

绝大部分灵长类动物存在与人类相似的ABO血型系统,该研究采用改良流式法(flow cytometry method,FCM)检测猕猴及食蟹猴血清中血型抗体水平的分布情况。以流式细胞术为基础,使用商品化人源红细胞为靶细胞,并通过加入特异性荧光标记的抗人IgM或IgG二抗,对收集的实验用猕猴及食蟹猴的血清样本进行检测,以人类健康受试者的血清样本为对照,比较两者血型抗体水平的差异。结果显示:预先用人O型浓缩红细胞吸附猴血清中所含种属间非特异性抗体后,FCM法能够准确检测其血型抗体水平及分型,并且发现猴血清中天然血型抗体的水平明显低于健康人(P<0.05)。由此得出:通过预处理清除非特异性抗体的干扰后,FCM法同样适用于灵长类动物血清中血型抗体的检测,也为构建灵长类动物模拟人ABO血型不合器官移植模型提供了技术保障和实验数据。     

Effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET)

This is a retrospective, observational study to evaluate the effect of maternal age on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). 11830 IVF-ET cycles from 10268 women were included. Four groups of different maternal age periods were compared. The groups were 21?C30 years old group (4549 cycles), 31?C35 years old group (4424 cycles), 36?C40 years old group (2429 cycles), and over 40 years old group (428 cycles). The mean starting dose of Gn and mean total dose of Gn in each cycle were significantly higher (P<0.01), while the mean retrieved oocyte number was significantly lower (P<0.01) in groups of higher maternal age period than those in each of the lower groups. The biochemical pregnancy rate and the clinical pregnancy rate were significantly lower (P<0.01), while the miscarriage rate was significantly higher (P<0.01) in groups of higher maternal age period than those in the lower groups. No difference was found in two-pronuclear zygotes (2PN) rate and good quality embryo rate among different groups. Birth defect rate was also comparable in the born babies in different groups. In the group with patients?? age over 40 years old, the pregnancy rate was 26.87%, the clinical pregnancy rate was 19.39%, while the miscarriage rate after clinical pregnancy was 36.14%. To draw the conclusion, patients with higher maternal age had worse IVF outcomes. In women of fertile age, patients between 20 and 30 years old have the best IVF outcomes. Patients over 40 years old have poor IVF outcome and high miscarriage rate, which suggested the necessity of preimplantation genetic screening (PGS).     

Brugia pahangi: circulating antibodies to adult worm antigens in uninfected progeny of homologously infected female jirds

Serum IgG antibody levels to adult Brugia pahangi antigens were measured in uninfected offspring from uninfected and B. pahangi-infected female jirds. Antibody titers to B. pahangi antigens in sera of offspring from infected females mimicked the maternal titer during the suckling period. Neonate titers peaked at 2 weeks of age at levels as high as 1:4100, then decreased to levels well below maternal titers by 8-12 weeks of age. Concurrent maternal and 2-week-old neonate sera recognized identical B. pahangi antigens in Western blots. Spleen cells from 2-week-old filariae-exposed and unexposed offspring failed to produce measurable antibody to B. pahangi in vitro. Progeny of uninfected mothers nursed by B. pahangi-infected females showed circulating IgG antibody titers to adult worm antigens similar to those of homologously reared offspring. Conversely, offspring born to B. pahangi-infected females and nursed by an uninfected female had no serum antibodies to B. pahangi antigens. Blastogenic responses of spleen cells to the mitogens phytohemagglutinin and pokeweed mitogen, and adult B. pahangi antigens, were not different between offspring groups. Mean areas of pulmonary granulomas induced by the intravenous inoculation of B. pahangi antigen-coated beads also did not differ between 4- and 8-week-old progeny of uninfected or infected females. These results suggest that the circulating IgG antibodies to adult B. pahangi antigens demonstrated in offspring of infected female jirds are maternally derived via the milk and do not alter the cellular responses of uninfected offspring to B. pahangi antigens as measured by antigen-stimulated blastogenesis or pulmonary granulomatous inflammatory response.     

Incidence of Maternal Rh Immunization by ABO Compatible and Incompatible Pregnancies

The incidence of maternal Rh immunization in Rh-negative women following a single ABO compatible Rh-positive pregnancy is about 17%. This incidence was determined by following Rh-negative women through two Rh-incompatible pregnancies and analysing their sera for anti-Rh at the time of delivery of their second observed pregnancy. Maternal Rh immunization occurs almost exclusively after delivery; however, antibodies may not be detectable in the absence of further antigenic stimulation.The incidence of maternal Rh immunization when maternal-foetal ABO incompatibility is also present is 9–13% and 17% for group O and non-group O women respectively. This study emphasizes the need to offer Rh-immune prophylaxis to Rh-negative women having Rh-positive infants whether or not ABO incompatibility exists between the mother and infant.     

Effects of environmental stress or ACTH treatment during pregnancy on maternal and fetal plasma androstenedione in the rat

Prenatal stress applied during the last trimester of pregnancy has been shown to alter fetal development and influence adult sexual behavior. Since androstenedione (Δ⁴) has the potential to participate in differentiation processes, this study was designed to assess the effect of prenatal stress on maternal and fetal Δ⁴ titers. Restraint/illumination/heat (environmental stress) or ACTH injections were used to stress pregnant rat dams beginning on Day 14 of pregnancy. Blood samples and organ weights were obtained from nonpregnant animals, pregnant rats on Days 5, 10, 15, 18, and 20 of pregnancy, and fetuses on Days 18 and 20 of gestation. Maternal and male and female fetal Δ⁴ titers were determined by radioimmunoassay. ACTH and environmental stress significantly reduced fetal body weight and male anogenital distance. Environmental stress also significantly reduced the size of 20-day fetal adrenals and testes. Each treatment caused significant short-term (1 hr after treatment) and long-term (16 hr after treatment) elevation of maternal plasma Δ⁴ on Days 15 and 18 of gestation, but only short-term elevation of Δ⁴ titers on Day 20. ACTH treatment did not cause long-term elevation of fetal Δ⁴ although both ACTH treatment and environmental stress generated a significant short-term increase in fetal Δ⁴ titers. Environmental stress produced long-term elevation of fetal Δ⁴ in 18-day fetuses of both sexes and in 20-day female fetuses. It is concluded that maternal stress and exogenous ACTH significantly elevate maternal and fetal Δ⁴ titers during the prenatal period postulated to be critical in sexual differentiation of the rat brain.