妊娠合并血小板减少症的病因学分析及其对母儿结局的影响

Etilolgy analysis of pregnancies complicated with thrombocytopenia and its influence to outcomes of pregnant woman and infant

目的观察妊娠期血小板减少症的病因及其对母儿结局的影响。方法回顾性分析我院收治的妊娠期血小板减少病例64例,根据孕期最低血小板计数分成四组。Ⅰ组:(50～100)X 109/L;Ⅱ组:(30～50)×109/L;Ⅲ组:(10～30)×109/L;Ⅳ组:<10×109/L。Ⅰ～Ⅳ组病例数依次为20、16、15和13例。比较各组患者发病原因,孕期并发症、治疗、新生儿结局。结果 64例妊娠合并血小板减少患者的病因分类中主要包括血小板减少症(PAT)、妊娠高血压疾病(HD-CP)、特发性血小板减少性紫癜(ITP),PAT占比最高,为45.3%;孕期及产后并发症包括HDCP、贫血、早产、产后出血及产褥感染等。贫血、早产、产后出血的患病率均随血小板减少程度加重而具有增加趋势(P<0.05),4组间差异有统计学意义(P<0.05);随母体血小板减少程度加重,新生儿血小板减少患病率增高。结论妊娠合并血小板减少症病因复杂,随着血小板减少程度加重,母体贫血、早产、产后出血及新生儿血小板减少的患病风险均有增加。严密的围生期保健可改善不同程度血小板减少患者的母儿结局。

Objective To observe the effect of gestational thrombocytopenia on outcome of pregnancy and the etiology of pregnancies complicated with thrombocytopenia.Methods The Clinical data of 64 pregnant women with thrombocytopenia were analyzed retrospectively.According to the minimal level of platelets in pregnancy,the patients were divided into 4 groups： group Ⅰ [platelets count was（50-100）×109/L,n=20];group Ⅱ [platelets count was（30-50）×109/L,n=16];group Ⅲ[platelets count was（10-30）×109/L,n = 15];group Ⅳ[platelets count was（0-10）×109/L,n=13].The etiology of pregnancies complicated with thrombocytopenia,demographic data such as pregnancy complications,treatment and outcomes of the patients in each group were analyzed.Results The major complications of pregnant women with thrombocytopenia were pregnancy associated thrombocytopenia（PAT）,hypertensive disorder complicating pregnancy（HDCP） and idiopathic thrombocytopenic purpura（ITP）,and PAT about 45.3%,which was the major cause of pregnant women with thrombocytopenia.Medical complications in pregnancy and puerperium of these patients were HDCP,anemia,preterm delivery,postpartum hemorrhage and puerperal infection.With the aggravation of thrombocytopenia,the morbidity of anemia,preterm delivery and postpartum hemorrhage were increasing.There were significant differences in the morbidity among the four groups（P 0.05）,and the morbidity of thrombocytopenia of neonatus increased with the aggravation of thrombocytopenia of their mother（P 0.05）.Conclusion The etiology of pregnancies complicated with thrombocytopenia is complex.With the aggravation of thrombocytopenia in pregnancy,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia are increasing.While the perinatal outcomes may be improved with the close perinatal care.