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目的评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响。方法对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析。结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa<0.01),各组间IgA、IgM水平无明显差异(Pa>0.05)。2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa<0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091)。3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185)。4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa<0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P<0.01)。结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响。
Objective To evaluate the changes of humoral immune status of newborns with hyperbilirubinemia before and after the exchange transfusion (exchange transfusion) and to understand the influence of transplanting on serum Ig in newborns. Methods Sixty-two neonates with hyperbilirubinemia were transfused. Serum Ig (IgG, IgA and IgM) levels were measured before and after treatment. The patients were divided into ABO hemolytic disease group, Rh hemolytic disease group, sepsis group And other groups for analysis. Results 1. Before transfusions, IgG levels in ABO hemolytic disease group and Rh hemolytic disease group were significantly higher than those in sepsis group and other groups (Pa, <0.01). There was no significant difference in IgA and IgM levels between groups (Pa> 0.05) . (2) The serum IgG levels in ABO hemolytic disease group and Rh hemolytic disease group were significantly lower than those before blood exchange (P <0.05), while the IgG levels in other groups and sepsis group were higher than those before blood exchange, but the difference was not statistically significant (P = 0.387,0.091). The level of IgA in 4 groups after exchange transfusion increased compared with before transfusions, and the difference was statistically significant (Pa = 0.000) before and after treatment in other groups, ABO hemolytic disease group and Rh hemolytic disease group, there was no statistics before and after treatment in sepsis group Significance of learning (P = 0.185). 4.After transfusion, the levels of IgM in 4 groups were all higher than those before transfusions, while the other groups, ABO hemolytic disease group and Rh hemolytic disease group were statistically significant before and after treatment (Pa <0.05), but there was no statistical difference in sepsis group before and after treatment (P = 0.081). The other groups, ABO hemolytic disease group and Rh hemolytic disease group after treatment were statistically significant (P <0.01). Pretreatment serum IgG levels in children with hemolytic disease is higher, exchange transfusion can rapidly reduce blood serum IgG levels in children with hemolytic disease, and improve blood IgA, IgM levels in children; 2. Transfusion of sepsis in children with serum IgG, IgA, IgM levels had no significant effect; 3. Exchange transfusions can increase serum IgA, IgM levels in children with other hyperbilirubinemia, but no significant effect on serum IgG levels.