Rh血型抗体的检测及结果分析

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 作者：吴远军, 吴勇, 陈宝婵, 刘艳

【摘要】 目的: 调查Rh血型抗体的检出率及其特异性分布特点, 分析Rh血型抗体的临床意义及产生规律。方法: 采用微柱凝胶抗球蛋白技术筛查和鉴定红细胞血型不规则抗体, 对鉴定为Rh血型抗体者, 采用单克隆抗�D、 抗�C、 抗�c、 抗�E、 抗�e鉴定红细胞Rh血型抗原, 以确认抗体的准确性; 检测抗体的效价、 Ig类型及37℃反应性, 以明确其临床意义; 询问孕产史、 输血史, 如果为新生儿检测其母亲血浆中是否有相同特异性的抗体, 以分析抗体产生的原因。结果: 就诊者54000例, 共检出Rh血型抗体47例, 检出率为0.087%, 其中有妊娠史者27例, 有输血史者13例, 既有妊娠史又有输血史者1例, 抗体来自母体的新生儿6例; 抗体的特异性为: 抗�E29例(61.70%)、 抗�D8例(17.02%)、 抗�cE5例(10.64%)、 抗�c4例(8.51%)、 抗�C1例(2.13%); 47例Rh血型抗体均为IgG或IgG+IgM类, 37℃均可与具有相应抗原的红细胞反应, 抗体效价介于1～4096。结论: 被检就诊者Rh血型抗体的检出率低于白种人; 在检出的Rh血型抗体中, 抗�E占绝对多数, 而抗�D的检出率呈逐步减少的趋势; 妊娠和输血引起的同种免疫是Rh血型抗体产生的原因,新生儿自母体被动获得的Rh血型抗体是Non�ABO�HDN最主要的致病抗体。

 

 

【关键词】  Rh血型 不规则抗体 免疫溶血性输血反应 新生儿溶血病 微柱凝胶抗球蛋白试验

　　[Abstract]  AIM: To study the prevalence and distribution of anti�Rh blood group antibodies in Chinese population and its clinical significance. METHODS: Irregular antibodies were screened and identified by Microcolum Gel Coomb’s test. For those identified as positive anti�Rh samples, monoclonal antibodies (anti�D, �C, �c, �E and �e) were used to identify the specific antigen and confirm the accuracy of the irregular antibody tests. The titers, Ig�types and 37℃�reactivity were tested to confirm its clinical siginificance. For evaluation of the origin of irregular antibodies, histories of pregnancy and transfusion were reviewed. For the newborns who had positive antibodies, their mothers were tested simultaneously to confirm the origin of the antibodies. RESULTS: 47 out of 54 000 (0.087%) patients were identified as positive with Rh blood group antibodies.Of them, 27 cases had history of pregnancy, 13 had transfusion and 1 had the histories of both. 6 newborns had antibodies derived form their mothers. The specificity of the antibody was as follows: 29 with anti�E  (61.70%), 8 with anti�D  (17.02%), anti�cE 5(10.64%), 4 with anti�c (8.51%) and 1 with anti�C (2.13%). All the 47 Rh blood group antibodies  were IgG or IgG+IgM, and were reactive to red blood cells with corresponding antigens at 37℃, with a highest titer of 1∶4 096. CONCLUSION: The prevalence of Rh antibodies is lower in Chinese population as compared with that in White population.Of all the antibodies, anti�E is  most frequently identified and anti�D was declining. Alloimmunization by pregnancy and transfusion is the major caus of Rh antibody production. Rh blood group antibodies derived from mothers are the major cause of Non�ABO�HDN.

　　[Keywords]Rh blood group; irregular antibodies; immune hemolytic transfusion reaction; haemolytic disease of the fetus and newborn; Microcolum Gel Coomb's test

 

　　Rh血型抗体是除ABO血型系统以外最具临床意义的红细胞血型抗体, 常引起免疫溶血性输血反应（HTR）及新生儿溶血病（HDN）, 调查Rh血型抗体的检出率及特异性分布情况, 了解Rh血型抗体产生的规律, 对预防HTR及HDN具有重要的临床意义。我们采用微柱凝胶抗球蛋白技术, 检测了54000例就诊者的红细胞血型不规则抗体, 共检出Rh血型抗体47例, 并对其产生的原因进行了调查分析。

 

　　1  材料和方法

　　1.1  材料  研究对象: 2004-05/2007-05, 在我院就诊的手术患者、 需要或预备输血的非手术患者、 孕妇、 部分新生儿及健康体检者共54000例, 其中男25000例, 女29000例, 年龄1 d～99岁。仪器试剂: 微柱凝胶抗球蛋白卡及专用孵育器、 离心机为长春博迅生物技术有限责任公司生产; 筛检红细胞、 谱红细胞为上海市血液生物医药有限公司生产; 0.2 mol/L2�Me（2�巯基乙醇）为本实验室配制; 单克隆抗�D、 抗�C、 抗�c、 抗�E、 抗�e为美国DBL公司生产。