Dooren M C, Kuijpers R W, Joekes E C, Huiskes E, Goldschmeding R, Overbeeke M A, von dem Borne A E, Engelfriet C P, Ouwehand W H
Department of Immunohaematology, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam.
Lancet. 1992 May 2;339(8801):1067-70. doi: 10.1016/0140-6736(92)90661-l.
The extent to which maternal anti-Rh(D) antibodies support lysis of erythrocytes by monocytes in the antibody-dependent cell-mediated cytotoxicity (ADCC) assay is closely correlated with the severity of Rh(D) haemolytic disease of the newborn infant (HDN). However, in some cases HDN is much milder than would be predicted from the ADCC value. We postulated that maternal ADCC-blocking alloantibodies against paternal antigens on monocytes can protect these infants against severe haemolysis. We studied 13 severely Rh(D)-alloimmunised mothers whose infants showed unexpectedly mild HDN (group I) and 14 women with similar ADCC values but whose infants had severe HDN (group II). 7 group-I women had monocyte-reactive IgG alloantibodies that inhibited lysis by paternal monocytes in the ADCC. No such antibodies were found in group II (p less than 0.01). In 6 of the 7 serum samples with monocyte-reactive antibodies, the antibodies had HLA-DR specificity. Our findings suggest that Rh(D)-positive children of some severely Rh(D)-alloimmunised women may be protected from severe HDN by maternal non-HLA-class-I, IgG alloantibodies against paternal monocyte blood-group antigens. These antibodies may inhibit the mononuclear phagocyte system of the fetus.
在抗体依赖性细胞介导的细胞毒性（ADCC）试验中，母体抗Rh（D）抗体支持单核细胞对红细胞进行裂解的程度与新生儿Rh（D）溶血病（HDN）的严重程度密切相关。然而，在某些情况下，HDN比根据ADCC值预测的要轻得多。我们推测，母体针对单核细胞上父系抗原的ADCC阻断同种抗体可以保护这些婴儿免受严重溶血。我们研究了13名严重Rh（D）同种免疫的母亲，她们的婴儿表现出意外轻微的HDN（I组），以及14名具有相似ADCC值但婴儿患有严重HDN的女性（II组）。I组中有7名女性具有单核细胞反应性IgG同种抗体，可在ADCC中抑制父系单核细胞的裂解。II组中未发现此类抗体（p小于0.01）。在7份具有单核细胞反应性抗体的血清样本中，有6份抗体具有HLA-DR特异性。我们的研究结果表明，一些严重Rh（D）同种免疫女性的Rh（D）阳性孩子可能受到母体针对父系单核细胞血型抗原的非HLA-I类IgG同种抗体的保护，免受严重HDN的影响。这些抗体可能会抑制胎儿的单核吞噬细胞系统。
