妊娠合并血小板减少215例临床分析

Clinical analysis of 215 cases of thrombocytopenia in pregnancy

目的探讨妊娠合并血小板减少患者的临床特点及其对母儿结局的影响。方法回顾性分析2016—2019年在广西医科大学第一附属医院住院分娩的215例妊娠合并血小板减少患者的临床资料。结果215例患者中妊娠期血小板减少症(GT)106例,妊娠期高血压疾病相关性血小板减少(HDP)47例,特发性血小板减少性紫癜(ITP)36例,其他原因26例,其剖宫产率(36.63%vs.84.44%vs.74.29%vs.73.08%)和新生儿血小板减少症(0.94%vs.0vs.36.11%vs.11.54%)比较差异均具有统计学意义(P<0.05),HDP组剖宫产率高且新生儿均无血小板减少,ITP组新生儿血小板减少率最高。GT组和HDP组轻中度血小板减少分别为83.96%(89/106)和93.62%(44/47),ITP组重度、极重度血小板减少占86.11%(31/36);血小板计数与剖宫产率呈负相关(r=-0.32,P=0.015)。分娩期输血率与血小板数值呈负相关(r=-0.35,P<0.05)。结论(1)妊娠合并血小板减少常见病因依次是GT、HDP和ITP。(2)不同原因和不同程度的妊娠合并血小板减少有不同的临床特点。(3)相比于GT,其他病因引起的血小板减少对母儿结局有更大程度的影响,尤其是ITP。

Objective To explore the clinical characteristics of pregnancy with thrombocytopenia and its influence on maternal and infant outcomes.Methods The clinical data of 215 pregnant women with thrombocytopenia hospitalized in the First Affiliated Hospital of Guangxi Medical University from 2016 to 2019 were retrospectively analyzed.Results Among the 215 patients,106 were with gestational thrombocytopenia(GT),47 were with thrombocytopenia(HDP)associated with hypertensive disorders in pregnancy,36 were with idiopathic thrombocytopenic purpura(ITP),and 26were with other causes;the incidence rate of cesarean section(36.63%,84.44%,74.29%,73.08%)and neonatal thrombocytopenia(0.94%,0,36.11%,11.54%)were statistically different(P<0.05).The HDP group had a higher cesarean section rate and no neonatal thrombocytopenia,while the ITP group had the highest neonatal thrombocytopenia rate.Most of the thrombocytopenia in GT group and HDP group were mild to moderate,accounting for 83.96%(89/106)and 93.62%(44/47),respectively.Most of the thrombocytopenia in ITP group were severe and extremely severe,accounting for 86.11%(31/36).Platelet count was negatively correlated with cesarean section rate(r=-0.32,P=0.015).The blood transfusion rate during delivery was negatively correlated with platelet count(r=-0.35,P<0.05).Conclusion s(1)The common causes of thrombocytopenia in pregnancy in turn are GT,HDP and ITP.(2)Different causes and degrees of pregnancy with thrombocytopenia have different clinical characteristics.(3)Compared with GT,thrombocytopenia caused by other causes,especially ITP,has a greater influence on maternal and infant outcomes.