mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-AOM-1977mimmun-1977Research ArticleОБЗОРЫREVIEWSМежгрупповой АВ0-конфликт матери и плода: роль антигликановых алло-антител в развитии гемолитической болезни новорожденныхAB0-incompatibility of mother and fetus: the role of anti-glycan alloantibodies in the hemolytic disease of newbornshttps://orcid.org/0000-0002-9829-673XОбуховаП. С.ObukhovaP. S.

Обухова Полина Сергеевна - к.х.н., старший научный сотрудник лаборатории клинической иммунологии

117997, Россия, Москва, ул. Миклухо-Маклая, 16/10

Obukhova Polina S. - PhD (Сhemistry), Senior Research Associate, Laboratory of Clinical Immunology

117997, Moscow, Miklukho-Maklay str., 16/10

polina@carb.ibch.ruКачановА. В.KachanovA. V.

студент

Москва

Student

Moscow

skyslark@yandex.ruПоздняковаН. А.PozdnyakovaN. A.

студент

Москва

Student

Moscow

pandary101@gmail.comhttps://orcid.org/0000-0003-1578-8403ЗиганшинаМ. М.ZiganshinaM. M.

к.б.н., ведущий научный сотрудник лаборатории клинической иммунологии

Москва

PhD (Biology), Leading Research Associate, Laboratory of Clinical Immunology

Moscow

mmz@mail.ruФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Министерства здравоохранения РФ; ФГБУН «Институт биоорганической химии имени академиков М.М. Шемякина и Ю.А. Овчинникова» Российской академии наукРоссияV. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology; M. Shemyakin and Yu. Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of SciencesRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Министерства здравоохранения РФ (Сеченовский университет)РоссияFirst Moscow State I. Sechenov Medical University (Sechenov University)Russian FederationФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Министерства здравоохранения РФРоссияV. Kulakov National Medical Research Center for Obstetrics, Gynecology and PerinatologyRussian Federation2021260220212311734Copyright © Обухова П.С., Качанов А.В., Позднякова Н.А., Зиганшина М.М., 20212021Обухова П.С., Качанов А.В., Позднякова Н.А., Зиганшина М.М.Obukhova P.S., Kachanov A.V., Pozdnyakova N.A., Ziganshina M.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mimmun.ru/mimmun/article/view/1977

Несовместимость матери и плода по резус-фактору, группе крови или другим факторам крови может приводить к гемолитической болезни плода и новорожденного (ГБН). ГБН – это клиническое болезненное состояние плода и новорожденного в результате гемолиза, когда материнские алло-антитела IgG класса проходят через плаценту и разрушают эритроциты плода и новорожденного. Оно возникает у плода внутриутробно и может резко усилиться сразу после рождения. В результате развивается гипербилирубинемия и анемия, что, в отсутствии должной терапии, может привести к выкидышу, серьезным осложнениям или смерти новорожденного. Спектр гемолитических болезней новорожденных в настоящее время сильно изменился по сравнению с прошлыми десятилетиями. Полвека назад ГБН рассматривали как почти полный синоним RhD аллоиммунизации, и это была частая проблема новорожденных. На сегодняшний день, благодаря высокой эффективности профилактики резус-конфликта, межгрупповые иммунологические конфликты по системе групп крови АВ0 стали наиболее распространенной причиной ГБН. Данный литературный обзор посвящен одной из главных причин желтухи и анемии новорожденных в настоящее время – ГБН в результате АВ0-конфликта (AB0-ГБН). В статье рассмотрены главные участники несовместимости групп крови матери и ребенка по системе АВ0, а именно А- и В-гликаны, а также соответствующие антигликановые алло-антитела. Пристальное внимание уделено особенностям структуры гликановых алло-антигенов системы АВ0 на эритроцитах плода и взрослого человека. Рассмотрена возможная взаимосвязь частоты и тяжести развития ГБН с группой крови матери и ребенка, а также с величиной титра материнских алло-антител, проведена оценка влияния подклассов иммуноглобулинов G на развитие AB0-ГБН. В большинстве случаев признаки АВ0-ГБН появляются, когда мать имеет первую (0) группу крови, а плод – вторую группу (подгруппу A1) или третью группу (В). Бывают и другие редкие комбинации АВ0-конфликтов. В таких случаях развиваются преимущественно тяжелые формы ГБН. В целом, этиология АВ0-ГБН сложная и на тяжесть развития ГБН влияет много факторов. Авторами проведен анализ статистических данных, а также распространенности АВ0-конфликта и АВ0-ГБН в различных районах мира. Кроме того, обсуждаются современные подходы к диагностике АВ0-ГБН. В настоящее время остается актуальной проблема возникновения и разработка путей преодоления АВ0-ГБН.

The mother and fetus incompatibility due to Rh-factor, blood group or other blood factors can lead to hemolytic disease of the fetus and newborn (HDN). HDN is a clinical disease condition of the fetus and newborn as a result of hemolysis, when maternal IgG alloantibodies cross the placenta and destroy the red blood cells of the fetus and newborn. The child disease begins in utero and can dramatically increase immediately after birth. As a result, hyperbilirubinemia and anemia develop, that can lead to abortions, serious complications, or death of the neonates in the absence of proper therapy. The range of HDN has changed significantly now compared to previous decades. Half a century ago, HDN was considered an almost complete synonym of RhD-alloimmunization, and this was a frequent problem for newborns. By now due to the high effective of Rh-conflict prevention, immunological AB0-conflicts have become the most common cause of HDN. The review aimes to one of the main causes of jaundice and anemia in neonates at present, i.e. HDN due to immunological AB0-conflict of mother and newborn (AB0-HDN). The main participants of the AВ0- incompatibility mother and child are considered, namely A- and B-glycans, as well as the corresponding anti-glycan alloantibodies. Close attention is paid to the structure features of glycan alloantigens on the red blood cells of the fetus and adult. The possible correlation of the frequency and severity of HDN with the blood group of mother and child, as well as with the titer of maternal alloantibodies, has been considered. The influence of immunoglobulin G subclasses on the AB0-HDN development has been evaluated. In most cases, AB0-HDN appear when the mother has the blood group 0, and the fetus has the group A (subgroup A1) or the group B. Other rare incidences of AB0-incompatibility with severe course are occurred. As a whole the etiology of AB0-HDN is complex and the HDN severity is influenced by many factors. The authors have analyzed statistical data, as well as the prevalence of AB0-incompatibility and AB0-HDN in various regions of the world. Current approaches to the diagnosis of AB0-HDN are discussed in addition. By now the problems of AB0- HDN occurrence and developing of ways to overcome this disease remain relevant.

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The authors declare that there are no conflicts of interest present.