Objective: To understand the serological characteristics of irregular antibodies in pregnant women and explore their clinical significance.
Methods: From January 2017 to March 2022, 151 471 pregnant women in Women and Children's Hospital of Chongqing Medical University were enrolled in this study, microcolumn gel card test was used for irregular antibody screening, and antibody specificity identification was further performed in some antibody-positive subjects.
Results: The positive rate of irregular antibody screening in the enrolled pregnant women was 0.91% (1 375/151 471), 0.23% (355/151 471) was detected in the first trimester, 0.05% (71/151 471) in the second trimester, and 0.63% (949/151 471) in the third trimester. The positive rate of irregular antibody screening in the third trimester was significantly higher than that in the first and second trimester, and a significant increase in the number of positive cases was found in the third trimester than that in the second trimester. The analysis of agglutination intensity of 1 375 irregular antibody screening positive results showed that the weakly positive agglutination intensity accounted for 50.11% (689/ 1 375), which was the highest, the suspicious positive was 18.69% (257/1 375), and the positive was 31.20% (429/1 375). The significant difference in distribution of agglutination intensity was not observed between the first trimester group and the second trimester group, however, in the third trimester, the proportion of suspicious positive and weakly positive was lower than the first trimester, while, the proportion of positive was higher than the first trimester, and the difference was statistically significant (P < 0.001). Among the irregular antibody screening positive pregnant women, the proportion of pregnant women with pregnancy number ≥ 2 was significantly higher than that with pregnancy ≤ 1. Among 60 pregnant women who underwent antibody identification, the distributions of the antibodies were as follows: Rh blood group system accounted for 23.33% (14/60), Lewis system 43.33% (26/60), Kidd system 3.33% (2/60), MNS system 16.67% (10/60), P1PK system 1.67% (1/60), autoantibodies 1.67% (1/60), and 4 cases was unable to identify (6.67%, 4/60). Among specific antibodies, the anti-Lea was the most common (30.00%), followed by anti-E (16.67%) and anti-M (16.67%).
Conclusion: The differences of irregular antibody serological characteristics exist in pregnant women from different regions with different genetic backgrounds, understanding the characteristics of irregular antibody in local pregnant women is of great significance for ensuring transfusion safety in pregnant women and preventing hemolytic disease of newborn.
题目: 孕产妇不规则抗体血清学特征和临床意义分析.
目的: 明确不规则抗体在孕产妇人群中的血清学特征，探讨其临床意义。.
方法: 选取2017年1月-2022年3月于重庆医科大学附属妇女儿童医院就诊的孕产妇151 471例，采用微柱凝胶抗人球蛋白法进行不规则抗体筛查，对部分抗体筛查阳性标本进一步做抗体特异性鉴定。.
结果: 孕产妇不规则抗体筛查阳性率为0.91%（1 375/151 471），其中0.23%（355/151 471）在孕早期检出，0.05%（71/151 471）在孕中期检出，0.63%（949/151 471）在孕晚期检出，孕晚期抗体阳性率明显高于孕早期和孕中期，且孕晚期新增阳性例数明显高于孕中期新增例数；分析1 375例不规则抗体阳性结果的凝集强度，其中凝集强度为弱阳性占比最高，为50.11%（689/1 375），可疑阳性占18.69%（257/1 375），阳性占31.20%（429/1 375），孕中期凝集强度分布与孕早期相比差异无统计学意义，但孕晚期可疑阳性和弱阳性的比例低于孕早期，阳性比例高于孕早期，比较差异有统计学意义（P <0.001）。不规则抗体阳性孕产妇中，妊娠≥2次孕产妇的占比明显高于≤1次者；进行抗体鉴定的60例孕产妇中，Rh系统占25.00%（15/60），Lewis系统占43.33%（26/60），Kidd系统占3.33%（2/60），MNS系统抗体占16.67%（10/60），P1PK系统抗体占1.67%（1/60），自身抗体占1.67%（1/60），4例无法确认特异性占6.67%（4/60）；特异性抗体中以抗-Lea（30.00%）最为常见，其次是抗-E （16.67%）和抗-M（16.67%）。.
结论: 不同地区、具有不同遗传背景的孕产妇人群的不规则抗体血清学特征存在差异，掌握本地区孕产妇不规则抗体的特征，对保证孕产妇输血安全、防治新生儿溶血病具有十分重要的意义。.
Keywords: antibody identification; irregular antibody; pregnant women; serological characteristics.