新生儿血小板减少症的病因及临床特点

Causes and Clinical Characteristics of Neonatal Thrombocytopenia

目的探讨新生儿血小板减少症(NT)的病因及临床特点。方法回顾性分析2a来本院就治的87例NT新生儿,对比不同胎龄NT的发病率,并分析病因,同时将87例NT患儿分为免疫性血小板减少组及非免疫性血小板减少组,收集各组患儿发病时间、严重程度、血小板恢复时间及住院时间等,应用SPSS10.0软件进行分析,采用单因素方差分析和χ2检验进行组间比较。结果 87例NT患儿中,足月儿41例,早产儿46例,早产儿发病率较足月儿明显增高(16.3%vs7.3%,P<0.01)。与非免疫性血小板减少症组(41例,47.1%)比较,免疫性血小板减少症组(46例,52.9%)的发病时间早、程度重,血小板恢复正常时间及住院时间均较长。针对病因给予抗感染、丙种球蛋白、地塞米松等治疗后,79例血小板恢复正常(90.8%),5例血小板计数升高后自动出院(5.8%),3例放弃治疗(3.4%)。其中5例患儿母亲经追踪检查,确诊免疫系统疾病。结论近年来免疫性血小板减少症逐渐增多,其发病早、程度重、恢复慢,但早诊断早治疗可取得良好疗效;在NT临床诊疗过程中应注意追查患儿及母亲的异常免疫因素。

Objective To investigate the causes and the clinical characteristics of neonatal thrombocytopenia（NT）.Methods Retrospective analysis was performed to compare the morbidity of term and preterm infants and analyze the causes of 87 infants with NT from Peking University People＇s Hospital in the last 2 years.These patients were divided into immune thrombocytopenia group,and non-immune thrombocytopenia group and the onset and severity of NT,recovery time of platelet and hospital stays were compared.SPSS 10.0 software was chosen for the statistical analysis.χ2 test and One-Way ANOVA were used for these comparisons.Results Forty-one cases were term infants and 46 cases were preterm infants.The morbidity of preterm infants（16.3%）was significantly higher than that in term infants（7.3%）（P0.01）.The morbidity of immune thrombocytopenia and non-immune thrombocytopenia was 52.9% and 47.1%,respectively.Compared with non-immune thrombocytopenia,the onset of immune thrombocytopenia was earlier,the platelet count was lower,the recovery time and the hospital stay was longer.After etiological treatments,such as anti-infection,gamma-globulin,dexamethasone,etc,79 patients（90.8%）were cured;5 patients（5.8%）were discharged voluntarily after platelet count was elevated but abnormal;3 patients（3.4%）gave up.Five mothers were confirmed with diseases of immune system by laboratory examination.Conclusions In recent years,the morbidity of immune thrombocytopenia gradually increased which is earlier outbreak,more severity and slower recovery.Earlier diagnosis and treatment can achieve better efficacy.Clinicians should pay more attention to the abnormal immune status of the infants and their mothers.