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静脉注射免疫球蛋白G治疗新生儿ABO溶血病,是神话还是现实?

Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?

作者信息

Beken Serdar, Hirfanoglu Ibrahim, Turkyilmaz Canan, Altuntas Nilgun, Unal Sezin, Turan Ozden, Onal Esra, Ergenekon Ebru, Koc Esin, Atalay Yildiz

机构信息

Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Gazi University, 06500 Besevler, Ankara Turkey.

出版信息

Indian J Hematol Blood Transfus. 2014 Mar;30(1):12-5. doi: 10.1007/s12288-012-0186-3. Epub 2012 Aug 28.

Abstract

Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n = 71) received one dose of IVIG (1 g/kg) and LED phototherapy whereas Group II (n = 46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1 ± 1.3 days in Group I and 2.27 ± 0.7 days in Group II (p < 0.05). Mean duration of hospital stay was 5.34 ± 2.2 days in Group I and 3.53 ± 1.3 days in Group II (p < 0.05). Mean duration of phototherapy was 4.0 ± 1.5 days and 2.73 ± 1.1 days in double and single doses of IVIG respectively, and this was statistically significant (p < 0.05). IVIG therapy didn't decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease.

摘要

静脉注射免疫球蛋白G(IVIG)疗法已被用作新生儿溶血病治疗的一个组成部分。对于其在新生儿ABO溶血病中的常规使用仍未达成共识。本研究的目的是确定对ABO血型不合的新生儿给予IVIG是否必要。117例ABO溶血病且库姆斯试验阳性的患者被纳入研究。除黄疸外,这些受试者均健康。婴儿被分为两组:第一组(n = 71)接受一剂IVIG(1 g/kg)和蓝光光疗,而第二组(n = 46)仅接受蓝光光疗。第一组有1例患者接受了红细胞输血,两组均未进行换血治疗。第一组光疗的平均持续时间为3.1±1.3天,第二组为2.27±0.7天(p<0.05)。第一组的平均住院时间为5.34±2.2天,第二组为3.53±1.3天(p<0.05)。IVIG双剂量和单剂量时光疗的平均持续时间分别为4.0±1.5天和2.73±1.1天,这具有统计学意义(p<0.05)。IVIG治疗并未缩短ABO溶血病婴儿的光疗时间和住院时间。对ABO溶血病婴儿进行细致的随访并结合蓝光光疗可降低发病率。IVIG未能在ABO溶血病中显示出预防溶血的作用。

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