344例妊娠期血小板减少合并肝功能异常临床分析

Clinical analysis of thrombocytopenia with dysfunction of liver in pregnancy

目的探讨妊娠期血小板减少患者的临床表现及与肝功能异常的相关分析。方法收集2013年妊娠期血小板减少344例作为观察组,按血小板(PLT)减少程度分2组:PLT≥50×109/L为A组(242例),PLT<50×109/L为B组(102例),同期随机选正常对照组为C组(101例)。记录其一般情况,孕期皮肤瘙痒、皮肤黏膜出血情况,肝功能指标、凝血功能指标及母婴预后。所有数据应用SPSS 16.0统计软件进行处理,计量资料采取单项方差分析,计数资料行χ2检验。结果 3组一般情况、早孕反应、皮肤瘙痒症状等相近,差异无统计学意义(P>0.05)。观察组肝功能异常和ICP发生率、剖宫产率、新生儿窒息率明显高于对照组,肝功能指标(ALT、AST、TBIL、DBIL、TBA)和凝血功能检查(PT、Fib、PTA、INR)也明显异于C组,差异均有统计学意义(P<0.05)。APTT、新生儿体重、产后出血3组相比差异无统计学意义。结论妊娠期血小板减少常与肝功能异常、ICP同时存在,并导致凝血功能异常,但对母婴预后无重大不良影响。本研究表明两者有一定相关性,但其病理基础及因果关系尚不明确,有待进一步临床和基础研究发现。

Objective To explore the clinical manifestation of thrombocytopenia with dysfunction of liver in pregnancy and its maternal-fetal outcome. Methods A total of 344 patients with thrombocytopenia in pregnancy from November 2012 to November 2013 were chosen as observation group. These patients were divided into two groups according the different level of thrombocytopenia：group A（242 cases with PLT≥50 × 10^9/ L） and group B（102 cases with PLT 50 × 10^9/ L）. Other101 cases were randomly collected to be control group（ group C） in same period. Then contrast observation was compared in three groups of the general conditions,itch of skin,exudation of mucous membrane and skin,liver function,thromboxane function and maternal-fetal outcome. Results There was no significant difference among three groups in the general conditions,itch of skin,neonate＇s weight and postpartum,activated partial thromboplastin time（ APTT）,P 〈0. 05. The incidence rate of observation groups was higher than control group in dysfunction of liver,ICP,uterine-incision delivery and neonatal asphyxia（ P 〈0. 05）. The liver functional parameters and thromboxane functional parameters of the observation group were significantly more abnormal than those in the control group（ P 〈0. 05）. Conclusion The thrombocytopenia in pregnancy was frequently complicated with dysfunction of liver and ICP,and results in coagulation disorder without important harmful effects in maternal-fetal outcome. There were closely relationship with thrombocytopenia and dysfunction of liver in pregnancy. But their pathophysiologic basis and causation need to be studied and researched in the future.