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目的探讨母儿ABO血型不合孕妇抗体效价的检测及药物治疗的临床意义。方法 2003年12月至2006年12月在我院分娩的IgG抗A(B)抗体效价>1∶64,孕期予药物(黄疸茵陈汤,葡萄糖+ViC静脉点滴,VitE口服)治疗的O型孕妇81例为研究组,选择同期在我院分娩的血IgG抗A(B)效价>1∶64但未予药物治疗的O型血孕妇29例为对照组,采用微粒凝胶法检测两组孕妇血清中IgG抗A(B)效价,效价64~256为低效价,抗体效价512~2048者为高效价;分析血清IgG抗A(B)高、低效价在孕中、晚期发生率的情况及其对妊娠结局的关系,分析药物及无药物治疗对妊娠结局的影响。结果 (1)妊娠中期(孕20周后)高效价发生率与妊娠晚期相比,差异无统计学意义(P>0.05)。(2)研究组中高效价发生率与对照组相比差异有统计学意义(P<0.05),研究组早产发生率与对照组相比差异无统计学意义(P>0.132)。研究组中剖宫产率与对照组相比差异无统计学意义。研究组中高胆红素血症发生率与对照组相比,差异无统计学意义。(3)研究组中高效价者早产率与低效价者相比差异有统计学意义(P<0.05);研究组中高效价者剖宫产率与低效价者对比差异无统计学意义(P>0.13)。研究组中高效价者新生儿高胆红素血症发生率与低效价者两者对比,差异无统计学意义(P>0.912),见表3。(4)研究组和对照组中无一例需产前药物促胎肺成熟,无发生新生儿RDS,新生儿窒息,新生儿胆红素性脑病,新生儿死亡;有3例新生儿贫血,其中研究组2例,对照组1例。结论 O型血IgG抗A(B)效价>1∶64的妊娠中、晚期孕妇高效价发生率与孕期无关,高效价与低效价孕妇的妊娠结局无显著性差异,提示不应单以效价的高低作为监测胎儿病情是否严重的唯一手段。本研究显示药物治疗与非药物治疗孕妇的妊娠结局无差异,提示给予药物治疗的传统方法的价值值得进一步探讨。
Objective To investigate the detection of antibody titer of pregnant women with ABO incompatible pregnant women and the clinical significance of drug treatment. Methods The antibody titer of IgG anti-A (B) antibody delivered in our hospital from December 2003 to December 2006 was 1:64. The therapeutic O (superscript o) was administered to pregnant women with jaundice caprine, glucose + ViC intravenously and VitE orally during pregnancy. Type pregnant women 81 cases of study group, select the same period in our hospital for delivery of blood IgG anti-A (B) titer> 1:64 but no drug treatment in pregnant women with type O as control group 29, using microgel method The titer of IgG anti-A (B) in serum of two groups of pregnant women was low from 64 to 256 and high titer from 512 to 2048. The serum IgG anti-A (B) Middle and late incidence and the relationship between pregnancy outcome, analysis of drug and drug-free treatment of pregnancy outcomes. Results (1) The incidence of high titer in the second trimester (20 weeks after pregnancy) was not significantly different from that in the third trimester of pregnancy (P> 0.05). (2) The incidence of high titer in the study group was significantly lower than that in the control group (P <0.05). There was no significant difference in the incidence of preterm birth between the study group and the control group (P> 0.132). Cesarean section rate in the study group compared with the control group, no significant difference. The incidence of hyperbilirubinemia in the study group compared with the control group, the difference was not statistically significant. (3) There was significant difference between the high-titer premature delivery rate and the low-titer rate in the study group (P <0.05). There was no significant difference between the high titer cesarean section rate and the low titer rate in the study group (P> 0.13). There was no significant difference between the two groups in the incidence of hyperbilirubinemia and high titer of high-titer neonates in the study group (P> 0.912) (Table 3). (4) None of the study group and the control group required prenatal drug to promote fetal lung maturity, no neonatal RDS, neonatal asphyxia, neonatal bilirubin encephalopathy, neonatal death; 3 cases of neonatal anemia, of which the study Group 2 cases, control group 1 case. Conclusion The prevalence of high titers in middle and late pregnant women with O-type IgG anti-A (B) titer> 1:64 is unrelated to that during pregnancy, and there is no significant difference in pregnancy outcomes between high-titer and low-titers pregnant women, suggesting that single The level of potency as the only means of monitoring fetal illness is serious. This study showed no difference in pregnancy outcome between drug-treated and non-drug-treated pregnant women, suggesting that the value of traditional methods of drug treatment warrants further investigation.