Bennett P R, Le Van Kim C, Colin Y, Warwick R M, Chérif-Zahar B, Fisk N M, Cartron J P
Royal Postgraduate Medical School, Institute of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, London.
N Engl J Med. 1993 Aug 26;329(9):607-10. doi: 10.1056/NEJM199308263290903.
An RhD-negative woman whose partner is heterozygous may have preexisting anti-RhD antibodies that may or may not affect a subsequent fetus, depending on whether it is heterozygous. A safe method of determining fetal RhD type early in pregnancy would eliminate the risks to an RhD-negative fetus of fetal-blood sampling or serial amniocenteses.
We determined the RhD type in 15 fetuses using the polymerase chain reaction in amniotic cells and serologic methods in fetal blood collected simultaneously. In another 15 fetuses, the RhD type determined from chorionic-villus samples was compared with that identified by typing of DNA from the fetus itself.
RhD typing of DNA from amniotic cells correctly indicated the serologic type in every fetus. Of 10 fetuses with RhD-negative mothers, 4 were identified as RhD-negative and 6 as RhD-positive. Of five fetuses with RhD-positive mothers, four were identified as RhD-positive and one as RhD-negative. There was also complete agreement between the results of RhD typing of DNA from chorionic-villus samples and the results of typing of DNA from fetal tissue. Eleven fetuses were RhD-positive, and 4 were RhD-negative. Four RhD-positive fetuses had RhD-negative mothers. Three RhD-negative fetuses had RhD-positive mothers. There was no contamination by maternal RhD-positive DNA of the samples from RhD-negative fetuses.
Determining fetal RhD type in amniotic cells without invading the fetomaternal circulation is a reliable method that will be valuable in the management of Rh alloimmunization.
伴侣为杂合子的RhD阴性女性可能预先存在抗RhD抗体，该抗体可能会或不会影响后续胎儿，这取决于胎儿是否为杂合子。在妊娠早期确定胎儿RhD血型的安全方法将消除对RhD阴性胎儿进行胎儿血采样或系列羊膜腔穿刺术的风险。
我们使用羊水细胞中的聚合酶链反应和同时采集的胎儿血中的血清学方法，对15例胎儿进行了RhD血型测定。在另外15例胎儿中，将绒毛膜绒毛样本确定的RhD血型与胎儿自身DNA分型确定的结果进行了比较。
羊水细胞DNA的RhD分型正确地表明了每个胎儿的血清学类型。在10例母亲为RhD阴性的胎儿中，4例被确定为RhD阴性，6例为RhD阳性。在5例母亲为RhD阳性的胎儿中，4例被确定为RhD阳性，1例为RhD阴性。绒毛膜绒毛样本DNA的RhD分型结果与胎儿组织DNA分型结果也完全一致。11例胎儿为RhD阳性，4例为RhD阴性。4例RhD阳性胎儿的母亲为RhD阴性。3例RhD阴性胎儿的母亲为RhD阳性。RhD阴性胎儿的样本未被母亲RhD阳性DNA污染。
在不侵入母胎循环的情况下确定羊水细胞中的胎儿RhD血型是一种可靠的方法，在Rh同种免疫的管理中具有重要价值。
