非重症原发免疫性血小板减少症患者2次妊娠母儿结局的自身对照研究

Maternal and infant outcomes of women with non-severe primary immune thrombocytopenia during two consecutive pregnancies: a self-controlled study

目的探讨非重症原发免疫性血小板减少症患者2次妊娠病情变化、母体并发症及新生儿情况。方法回顾性分析2010年6月至2020年6月北京大学人民医院收治的40例具有2次分娩结局的非重症原发免疫性血小板减少症患者的临床资料,比较患者2次妊娠期不同阶段血小板计数、药物治疗、母体并发症及新生儿情况。采用χ^(2)检验、Fisher精确概率法、配对样本t检验、Wilcoxon符号秩检验、独立样本t检验、Mann-WhitneyU检验进行统计学分析。结果40例非重症原发免疫性血小板减少症患者中,18例为初产妊娠前诊断,22例为初产妊娠期首次诊断,2次妊娠前血小板水平及治疗情况比较,差异均无统计学意义(P值均>0.05)。二胎组与初产组比较,妊娠早、中、晚期平均血小板计数及血小板轻、中、重度减少患者的构成比,母体出血评分及药物治疗率构成比差异均无统计学意义(P值均>0.05)。2次妊娠期母体并发妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、早产、贫血的发生率比较差异也均无统计学意义(P值均>0.05)。二胎组产后出血及严重产后出血发生率分别为30.0%(12/40)和22.5%(9/40),分别高于初产组的7.5%(3/40)和5.0%(2/40)(χ^(2)值分别为6.64和5.17,P值分别为0.010和0.023);二胎组产后出血量高于初产组[500 ml(213~795 ml)与300 ml(163~400 ml),Z=-2.34,P=0.019]。二胎组新生儿出生体重、被动免疫性血小板减少症发生率、颅内出血发生率及病死率与初产组比较,差异均无统计学意义(P值均>0.05);二胎组新生儿出生1周内最低血小板计数为(202.2±106.7)×10^(9)/L,低于初产组[(222.5±91.8)×10^(9)/L,Z=-2.04,P=0.041]。结论非重症原发免疫性血小板减少症患者二胎妊娠与初产相比原发病情无明显加重,妊娠期母体并发症发生率无明显增加,但分娩期产后出血风险增加,新生儿被动免疫性血小板减少症发生率增高。

Objective To understand the progress,maternal morbidity,and maternal and infant outcomes in pregnant women with non-severe primary immune thrombocytopenia(ITP)during two consecutive pregnancies.Methods This study retrospectively analyzed the clinical data of 40 patients with non-severe ITP who had two pregnancies and were treated at Peking University People's Hospital between June 2010 and June 2020.Platelet counts at different stages of pregnancy,treatments,maternal complications and neonatal outcomes were compared with Chi-square test,Fisher's exact test,paired sample t-test,non-parametric Wilcoxon signed rank test,independent sample t-test or non-parametric Mann-Whitney U test.Results Among the 40 patients,18 were diagnosed before and 22 were first diagnosed during the first gestation.Platelet counts and treatments in the 18 patients prior to their first conception were not significantly different from those in the 40 patients before their second pregnancy(all P>0.05).No significant difference in the average platelet count and thrombocytopenia severity at each stage of pregnancy,and maternal bleeding score or drug treatment was observed between the two pregnancies(all P>0.05),neither in the incidence of gestational hypertension,gestational diabetes,premature rupture of membranes,premature delivery,or anemia(all P>0.05).The incidences of postpartum hemorrhage and severe postpartum hemorrhage in the second pregnancy were 30.0%(12/40)and 22.5%(9/40),respectively,which were both higher than those in the first gestation[(7.5%(3/40)and 5.0%(2/40);χ^(2)=6.64,5.17;P=0.010,0.023].The amount of postpartum hemorrhage was higher in the second pregnancy than in the first[500 ml(213-795 ml)vs 300 ml(163-400 ml),Z=-2.34,P=0.019].There was no significant difference in birth weight,the incidence of passive ITP or intracranial hemorrhage,or mortality between the neonates of the first and second pregnancy group(all P>0.05).The lowest platelet count in neonates within one week after birth in the second pregnancy group was(202.2±106.7)×10^(9)/L,which was lower than that of the first[(222.5±91.8)×10^(9)/L,Z=-2.04,P=0.041].Conclusions Non-severe ITP is not worse in the second pregnancy than in the first.In women with non-severe ITP,the incidence of maternal complications is not increased in the second pregnancy,but the risk of postpartum hemorrhage and the incidence of neonatal passive immune thrombocytopenia are raised.