妊娠期首发血小板减少的临床诊断及原因分析

Clinical diagnosis and etiologic analysis of pregnancy-associated thrombocytopenia

目的探讨妊娠期首发血小板减少的临床诊断特点并分析其原因。方法回顾性分析180例首发血小板减少的孕妇临床资料,总结其病因分布、发病时间、血小板减少程度、分娩方式和产后出血以及产后恢复等情况。结果妊娠期首发血小板减少的主要原因为妊娠期血小板减少症(gestational thrombocytopenia,GT)和特发性血小板减少性紫癜(idiopathic thrombocytopenia purpura,ITP),分别占64.4%、26.1%。GT主要发生于妊娠中、晚期,血小板倾向于轻、中度减少;轻度血小板减少患者主要采用阴道分娩或人工助产,产后出血率为3.5%,中度血小板减少者主要采用剖宫产,产后出血率为21.3%,患者于产后半年内恢复正常。ITP主要发生于妊娠早、中期,血小板倾向于重度减少,患者主要采用剖宫产,产后出血率约为50%,57.4%患者于产后半年后仍未恢复。结论妊娠期首发血小板减少的主要病因为GT和ITP,两者在血小板减少的程度、发病时间、对分娩方式的选择、产后出血以及产后恢复情况上均有差异。

Objective To explore the etiology and clinical diagnosis of pregnancy-associated thrombocytopenia. Method A retrospective analysis was conducted on clinical data of 180 patients. The onset time of thrombocytopenia,platelet changes,maternal and perinatal outcomes as well as follow-up conditions were analyzed respectively based on the etiology. Findings The main cause of pregnancy-associated thrombocytopenia was gestational thrombocytopenia（ 116 /64. 4%）,followed by idiopathic thrombocytopenia purpura（ 47 /26. 1%）. Gestational thrombocytopenia occurred during second and third trimester of pregnancy with mild and moderate thrombocytopenia. Most patients with mild thrombocytopenia were opted for vaginal delivery with a postpartum bleeding of 3. 5%. Patients with moderate thrombocytopenia were opted for cesarean section with a postpartum bleeding of 21. 3%. Most patients recovered within half a year. In contrast,ITP often occurred during first and second trimesters of pregnancy with severe thrombocytopenia. Patients with severe thrombocytopenia were opted for cesarean section with a postpartum bleeding of 50. 0%. Most patients remained uncovered after half a year of postpartum. Conclusion The most common etiology of pregnancy-associated thrombocytopenia is GT,followed by ITP.There are significant differences in the degree of platelet counts,the onset time of thrombocytopenia,the delivery and bleeding conditions postpartum and recovery conditions between GT and ITP patients.