早产儿血小板减少症与母亲胎盘病理特点的关系

Association between premature thrombocytopenia and placental pathology

目的:探讨早产儿血小板减少症与母亲胎盘病理特点的关系。方法:纳入2015年1月1日至12月31日在广州医科大学附属广东省妇儿医院娩出并入住新生儿重症监护室(neonatal intensive care unit,NICU)72 h内血小板计数小于100×109个/L的单胎早产新生儿(出生胎龄<37周)作为实验组,并按胎龄匹配纳入同期分娩的血小板计数正常的单胎早产新生儿作为对照组。对胎儿血栓性血管病变(fetal thrombotic vasculopathy,FTV)、胎盘梗塞性病变、脐带扭转、胎盘组织学炎性浸润等胎盘病理特点进行回顾性研究,并对所得数据进行统计学分析。结果:实验组(106例)和对照组(198例)出生胎龄分别为(31.74±2.10)和(31.92±2.06)周,差异无统计学意义(P>0.05)。对照组早产新生儿出生体重[(1 763.59±429.36)g]高于实验组[(1 659.72±422.21)g],差异有统计学意义(P<0.05)。实验组合并胎盘功能不全情况比例(先兆子痫17.9%,胎儿宫内生长迟缓9.4%)高于对照组(先兆子痫6.1%,胎儿宫内生长迟缓2.5%),差异有统计学意义(P<0.05)。两组胎盘重量[(381.98±107.10)g和(397.05±114.28)g]比较,差异无统计学意义(P>0.05)。实验组FT V的比例(23.6%)及胎盘梗死性改变的比例(35.8%)均高于对照组(分别为12.1%和16.7%),差异均有统计学意义(P<0.05)。实验组脐带扭转及胎盘组织学炎性浸润的比例与对照组比较,差异无统计学意义(P>0.05)。结论:早产新生儿血小板减少症与胎盘梗死性改变及FTV有关,与单纯的胎盘组织炎性浸润情况无关。

Objective： To investigate the association between premature thrombocytopenia and placental lesions. Methods： Cases included singleton premature infants admitted to the neonatal intensive care unit of Guangdong Women and Children＇s Hospital, Guangzhou Medical University from January 1, 2015 to December 31, 2015 with platelet counts 100×109/L. We selected a contemporaneous control group matched for gestational age. The frequency of fetal thrombotic vasculopathy, infarcts, cord insertion and histological inflammation were identified on retrospectively reviewed. Pearson Chi-Square Test was used to test for associations analyzation. Results： The average gestational age of the thrombocytopenia group（106 cases） and the control group（198 cases） was（31.74±2.10） weeks and（31.92±2.06） weeks, respectively. The birth weight of the preterm neonates in the control group [（1 763.59±429.36） g] Was higher than that of the experimental group [（1 659.72±422.21） g], the difference was statistically significant（P0.05）. The rate of placental insufficiency（preeclampsia 17.9% and intrauterine growth retardation 9.4%） were higher than those in the control group（preeclampsia 6.1%, intrauterine growth retardation 2.5%）; the difference was statistically significant（P0.05）. There was no significant difference in the average placental weight between the 2 groups [（381.98±107.10） g and（397.05±114.28） g]. The frequency of fetal thrombotic vasculopathy（23.6%） and placental infarcts（35.8%） in the thrombocytopenia group were higher, the difference was statistically significant（P0.05）. The frequency of histological inflammation and umbilical cord torsion between the groups are not statistically significant（P0.05）. Conclusion： Placental infarcts and poor fetal vascular lesions, but not histological inflammation, are associated with thrombocytopenia in the premature infants.