Anti-D外來抗原免疫反應治療法有助於治療Anti-E外來抗原免疫反應


  Jan. 14, 2005 - 一項刊載於一月份婦產科學誌的研究指出,Anti-D外來抗原免疫反應的治療法,可有效的用在Anti-E外來抗原免疫反應的治療;大多數情況下,胎兒的情況可以由母體的血液檢驗看出,力價超過1:32就可以作更進一步的研判。
  
  俄亥俄州立大學的Saju D. Joy醫師表示,雖然E抗原所導致的外來抗原免疫反應已經被了解,但是其在胎兒或新生兒身上所引發的溶血性疾病,直到目前仍有爭議;非典型抗體在懷孕時所引發的外來抗原免疫反應,一般都是以anti-D外來抗原免疫反應的處理方式來治療。
  
  在1959年1月到2004年4月間,有283例的孕期anti-E外來抗原免疫反應,因為其胎兒或新生兒經直接抗血球蛋白試驗後出現陽性反應,或E抗原測試出現陽性反應;研究人員蒐集了抗體力價的資料,含deltaOD450值、Liley zones、中大腦動脈收縮量最大速度,胎兒及新生兒的紅血球及抗原測試,胎兒及新生兒的直接抗血球蛋白試驗。
  
  這283例中,27位婦女的32個孕期因為anti-E而使得胎兒或新生兒暴露在溶血病變的高危險中,有16個孕期的力價超過1:32,其中15個孕期是以羊膜穿刺進行deltaOD450試驗後證實。
  
  和血液試驗合併,deltaOD450在zone IIB或zone III的檢驗結果,足以證實孕期是否患有胎兒性或新生兒性的貧血。
  
  32位胎兒中,有5位(15%)的Hb濃度低於10g/dL,有一個胎兒因anti-E外來抗原免疫反應的關係而有胎兒水腫的現象,有一個死亡案例是在出生前後發生的,原因是anti-E溶血性病變,兩例皆測量過中大腦動脈收縮量最大速度,其結果也經過羊膜穿刺法證實。
  
  Joy醫師指出,Anti-E外來抗原免疫反應會導致溶血性的疾病,這類的胎兒或新生兒必須要在產前就接受治療;從此次研究的患者可以看出,Rh D外來抗原免疫反應的臨床治療法,包含母體血液檢驗,羊膜液測光分析法,及胎兒血液樣本檢驗等,都可以用來監測E外來抗原免疫反應。
  
  該項研究的限制因素,包括為一回顧性的研究、樣本偏差、Liley圖譜經過修正,這可能會和其他用途所用的不一致。
  
  Joy醫師總結指出,我們的數據顯示,血清力價超過1:32時,後續的評估就可以進行,例如羊膜穿刺、臍帶血管穿刺;甚至,可以用子宮內投藥的方式來作治療。

Strategies for Anti-D Alloimmu

By Laurie Barclay, MD
Medscape Medical News

Jan. 14, 2005 — Strategies similar to those used for anti-D alloimmunization are useful for anti-E alloimmunization, according to the results of a study published in the January issue of Obstetrics & Gynecology. In most cases, the fetus can be monitored using maternal serology, with a titer of 1:32 or greater prompting further investigation.

"Although it is established that the E antigen can cause alloimmunization, the effect in causing clinically significant hemolytic disease of the fetus or newborn continues to be debated," write Saju D. Joy, MD, from the Ohio State University College of Medicine and Public Health in Columbus, and colleagues. "Pregnancies complicated by alloimmunization due to any of the atypical antibodies are generally managed using clinical strategies established for anti-D alloimmunization."

A review of records from June 1959 to April 2004 identified 283 pregnancies affected by anti-E alloimmunization, based on a positive direct antiglobulin test or positive E antigen typing in the fetus or newborn. The investigators collected data on antibody titers, deltaOD450 values, Liley zones, middle cerebral artery peak systolic velocity, fetal and neonatal hemoglobin (Hb) and antigen typing, fetal and neonatal direct antiglobulin test, and outcomes.

Of the 283 pregnancies with anti-E alloimmunization, 32 pregnancies in 27 women were at risk for hemolytic disease of the fetus or newborn from anti-E only and had complete records. Of these 32 pregnancies, 16 had titers greater than or equal to 1:32, and 15 pregnancies had amniocenteses performed for deltaOD450.

In combination with serologic titers, values of deltaOD450 in zone IIB or zone III identified all pregnancies with fetal or neonatal anemia.

In five (15%) of 32 fetuses, Hb was less than 10 g/dL. One fetus had hydrops fetalis caused by anti-E alloimmunization, and one perinatal death was attributed to anti-E hemolytic disease of the fetus or newborn. In two cases in which middle cerebral artery peak systolic velocity was measured, it confirmed information obtained from amniocentesis.

"Anti-E alloimmunization can cause hemolytic disease of the fetus or newborn requiring prenatal intervention," the authors write. "Based on our population, clinical strategies developed for Rh D alloimmunization using maternal serology, amniotic fluid spectrophotometry, and fetal blood sampling are useful in monitoring E alloimmunization."

Study limitations include its retrospective nature, selection bias, and the use of a modified Liley graph that may differ from that used elsewhere.

"Our data show that a critical serologic titer of 1:32 in the absence of a previously affected fetus warrants further evaluation with amniocentesis, cordocentesis, and possible treatment with intrauterine transfusion," the authors conclude.

Obstet Gynecol. 2005;105:24-28

Reviewed by Gary D. Vogin, MD

    
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