妊娠合并特发性血小板减少性紫癜36例临床分析

Clinical analysis on 36 pregnancy women with idiopathic thrombocytopenic purpura

目的探讨妊娠合并特发性血小板减少性紫癜（ITP）母婴结局。方法回顾性分析2002年1月至2009年12月间妊娠合并ITP患者临床资料,参照第二届全国血液病学术会议制定的ITP诊断标准,按治疗时血小板计数情况分组,血小板计数（50~100）×109/L为Ⅰ组共14例,血小板计数〈50×109/L为Ⅱ组共22例。记录Ⅱ组ITP患者给予糖皮质激素（泼尼松）,丙种球蛋白及（或）血小板悬液治疗后的临床效果及其母儿的围产结局。结果两组患者治疗前凝血功能、临床表现比较差异有统计学意义,经治疗后产后出血、新生儿ITP、颅内出血比较差异无统计学意义。仅分娩方式比较差异有统计学意义（Ⅱ组患者剖宫产率较高）。结论妊娠合并ITP对母儿均有潜在的危险,加强围产期管理,根据轻重程度积极治疗可改善妊娠结局。

Objective To investigate the outcome of pregnancy women with idiopathic thrombocytopenic purpura (ITP) and their infants. Methods The clinical data of 36 pregnancy women with ITP in People’s Hospital of Hainan Province from Jan. 2002 to Dec. 2009 were analyzed. The patients were divided into two groups according blood platelets count (BPC), GroupⅠ[BPC (50~100)×109/L, n=14], and Group Ⅱ [BPC<50×109/L, n=22]. The outcome of mothers and infants as well as the therapeutic efficacy in Group Ⅱ after treated by glucocorticoids, gamma globulin and transfusion of platelets were recorded. Results The patients’ blood clotting function and clinical situation before operation showed statistically significant difference between the two groups, but postpartum hemorrhage, neonatus's ITP and intracranial hemorrhage had no statistically significant difference after treatment. The rate of cesarean delivery in group Ⅱ were significantly higher than that in group Ⅰ. Conclusion Pregnancy combined with ITP exerts risks for both mother and infants. The outcome of pregnancy could be improved by intensive management and active treatment.