海南医科大学学报

目的：探讨二孩孕妇Rh血型系统5个抗原的表型分布和Rh血型不规则抗体特异性情况，分析二孩孕妇Rh血型抗体与新生儿溶血病（hemolytic disease of the newborn,HDN）的关系，为Rh新生儿溶血病（Rh-HDN）的诊治提供实验室依据。方法：收集二孩孕妇500例作为研究组，初次妊娠孕妇500例作为对照组（均为2020年1月～2021年1月在我院一体化产科门诊进行产检的孕妇），检测两组标本的Rh血型抗原（D、C、c、E、e五个抗原）、不规则抗体检测、抗体特异性鉴定和效价测定，跟踪新生儿溶血病的发生情况。结果：研究组500例二孩孕妇中共有12种Rh血型表型，分别为：CCDee(152例，30.4%),CcDEe(136例，27.2%),CcDee(84例，16.8%),ccDEE(30例，6%),ccDee(31例，6.2%),CCDEe(14例，2.8%),ccDEe(9例，1.8%),ccdee(18例，3.6%),CCDEE(2例，0.4%),CcdEe(12例，2.4%),Ccdee(6例，1.2%),CCdee(6例，1.2%)，其中RhD阴性的二孩孕妇共42例，比例为8.4%。对照组500例初次妊娠孕妇，共有11种Rh血型表型，分别为：CCDee(144例，28.8%),CcDEe(138例，27.6%),CcDee(90例，18%),ccDEE(42例，8.4%),ccDee(28例，5.6%),CCDEe(10例，2%),ccDEe(8例，1.6%),ccdee(19例，3.8%),CCDEE(1例，0.2%),CcdEe(11例，2.2%),Ccdee(9例，1.8%)，其中RhD阴性的初次妊娠孕妇共39例，比例为7.8%。研究组二孩孕妇不规则抗体检测阳性率为4.0%(20/500),Rh血型抗体的特异性分别为：抗-E 1.8%(9/500)，抗-D 1.4%(7/500)，抗-C 0.4%(2/500)，抗-Ec 0.4%(2/500)；对照组初次妊娠孕妇不规则抗体检测阳性率为0。二孩孕妇与初次妊娠孕妇不规则抗体检测阳性率的差异有统计学意义（P<0.05）。二孩孕妇中共有10例分娩的新生儿发生Rh新生儿溶血病，占2%(10/500)，且孕期Rh抗体效价均大于32；初次妊娠孕妇分娩的的新生儿未发生Rh新生儿溶血病，差异有统计学意义（P<0.05）。结论：妊娠刺激可增加孕妇产生不规则抗体的概率，Rh血型不规则抗体容易引起Rh-HDN，应重视孕妇产检期间Rh血型5个抗原和不规则抗体的常规检测，有助于早期发现Rh血型不规则抗体及评估胎儿或者新生儿发生Rh-HDN的风险。

Objective:To investigate the phenotype distribution of five antigens of the Rh blood group system and the specificity of Rh blood group irregular antibodies in pregnant women with a second pregnancy,and to analyze the relationship between Rh blood group antibodies and hemolytic disease of the newborn(HDN)in second-child pregnant women,and to provide laboratory basis for the diagnosis and treatment of hemolytic disease of the newborn(Rh-HDN). Methods:A total of 500 pregnant women with a second pregnancy were collected as the study group and 500 pregnant women with first pregnancy as the control group(all pregnant women underwent an obstetric examination in the integrated obstetric clinic of our hospital from January 2020 to January2021 were included). Rh blood group antigens(D,C,c,E,e)of the two groups,the irregular antibodies,the specificity of irregular antibodies,the titer,and the hemolytic disease of the newborn of pregnant women with positive Rh blood group antibodies were determined. Results:There were 11 Rh phenotypes in the pregnant women with a second pregnancy in the study group:CCDee(152 cases,30.4%),CcDEe(136 cases,27.2%),CcDee(84 cases,16.8%),ccDEE(30 cases,6%),ccDee(31 cases,6.2%),CCDEe(14 cases,2.8%),ccDEe(9 cases,1.8%),ccdee(18 cases,3.6%),CCDEE(2 cases,0.4%),CcdEe(12 cases,2.4%),Ccdee(6 cases,1.2%),and CCdee(6 cases,1.2%). A total of 42 cases(8.4%)in the pregnant women with a second pregnancy were negative for RhD. There were 10 Rh phenotypes in the pregnant women with first pregnancy in the control group:CCDee(144 cases,28.8%),CcDEe(138 cases,27.6%),CcDee(90 cases,18%),ccDEE(42 cases,8.4%),ccDee(28 cases,5.6%),CCDEe(10 cases,2%),ccDEe(8 cases,1.6%),ccdee(19 cases,3.8%),CCDEE(1 cases,0.2%),CcdEe(11 cases,2.2%),and Ccdee(9 cases,1.8%). A total of 39 cases(7.8%)in the pregnant women with first pregnancy were negative for RhD. In the pregnant women with a second pregnancy in the study group,the positive rate of irregular antibody screening was 4.0%(20/500),and the specificity of Rh blood group antibodies were found as follows:anti-E of 1.8%(9/500),anti-D of 1.4%(7/500),anti-C of 0.4%(2/500)and anti-Ec of 0.4%(2/500). The positive rate of irregular antibody screening in the pregnant women with first pregnancy in the control group was 0,and the difference between the two groups was statistically significant(P<0.05). Rh-HDN was found in 10 newborns(2%)of the women with positive irregular antibodies in the pregnant women with a second pregnancy,and the antibody titer during pregnancy was more than 32. No Rh-HDN occurred in newborns in the pregnant women with the first pregnancy,and the difference between the two groups was statistically significant(P<0.05). Conclusion:Pregnancy stimulation can increase the probability of irregular antibodies in pregnant women,and irregular antibodies in the Rh blood group can easily cause Rh-HDN,so attention should be paid to routine detection of 5 antigens of the Rh blood group and irregular antibody screening during the prenatal examination. It is helpful for the early detection of Rh-blood irregular antibodies and the assessment of the fetal or neonatal risk of Rh-HDN.