单核细胞单层试验在预测IgG抗-M相关胎儿新生儿溶血病中的应用OACSTPCD
Application of monocyte monolayer assay on hemolytic disease of fetus and newborn caused by IgG anti-M
目的 探讨单核细胞单层实验(monocyte monolayer assay,MMA)是否能够用于IgG抗-M相关胎儿新生儿溶血病(hemolytic disease of fetus and newborn,HDFN)的预测.方法 选取 8 例含有IgG抗-M的孕妇并采集血浆标本,其中有胎儿水肿等严重临床症状及无明显临床症状的各 4 例;8 份血浆用二硫苏糖醇(dithiothreitol,DTT)灭活,与M抗原阳性红细胞孵育致敏后,将致敏红细胞与单核细胞混合进行吞噬试验,同时设立阳性及阴性对照,并计算吞噬率;采用t检验对 2 组吞噬率进行比较.结果 4 例发生严重抗-M相关HDFN的孕妇的MMA吞噬率分别为15.37%、13.05%、9.17%和 24.50%,均值为 15.52%;检出IgG抗-M但未发生HDFN的孕妇,其MMA吞噬率分别为8.74%、11.07%、5.12%和 6.23%,均值为 7.79%,2 组吞噬率无差异(P>0.05).2 组吞噬率分别与阴性对照比较均无差异(P>0.05),但均明显低于阳性对照(P<0.05).结论 IgG抗-M介导单核细胞吞噬的能力较低,提示抗-M导致胎儿水肿的机制可能并非红细胞被吞噬破坏而发生的溶血,因此体外单核细胞单层实验可能不适用于IgG抗-M相关HDFN的预测.对于检出IgG抗-M的孕妇,现仍需通过定期监测胎儿大脑中动脉血流,来判断胎儿宫内贫血情况.
Objective To elucidate the prediction ability of monocyte monolayer assay(MMA)used in hemolytic dis-ease of fetus and newborn(HDFN)caused by IgG anti-M.Methods Plasma from eight pregnant women containing IgG an-ti-M were collected,and were divided into two groups(4 cases with HDFN,with severe clinical symptoms such as fetal hy-drops,and 4 cases without HDFN)according to the clinical outcomes.M antigen positive cells were sensitized with dithioth-reitol(DTT)treated plasma from eight pregnant women respectively.MMA was performed by coincubation with monocytes and sensitized M cells,along with negative and positive control set up.T-test was conducted to compare the difference in phagocytic efficiency between two groups.Results The phagocytic efficiency in group with HDFN were 15.37%,13.05%,9.17%and 24.50%respectively,with the mean value of 15.52%,while the group without HDFN were 8.74%,11.07%,5.12%and 6.23%respectively,with the mean value of 7.79%.There was no significant difference in phagocytic efficiency between two groups(P>0.05).The mean values of both groups were not significantly different from the negative control(P>0.05),but both were significantly lower than positive control(P<0.05).Conclusion The low phagocytic efficiency couldn't convince that the MMA is an effective predictor for the HDFN caused by IgG anti-M,indicating that another mech-anism might be responsible for it rather than monocyte phagocytosis.The assessment of the peak systolic velocity in middle cerebral artery of the fetal should be considered in the management for pregnant women who produce IgG anti-M to estimate the situation of fetal anemia.
莫春妍;贾双双;朱思颖;姬艳丽;邵媛;廖志坚;罗广平;魏玲
广州血液中心 广州医科大学输血与血液病研究所 广州市血液安全重点实验室,广东 广州 510095
临床医学
单核细胞单层试验(MMA)IgG抗-M胎儿新生儿溶血病(HDFN)
monocyte monolayer assay(MMA)IgG anti-Mhemolytic disease of fetus and newborn(HDFN)
《中国输血杂志》 2024 (006)
643-647 / 5
广州市卫生健康科技项目(20211A010055);广东省医学科学技术研究基金项目(B2023201)
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