单胎妊娠合并再生障碍性贫血孕妇母婴结局及影响因素

Maternal and infant outcomes and influencing factors of singleton pregnancy complicated with aplastic anemia

目的:探究单胎妊娠合并再生障碍性贫血(PCAA)孕妇母婴结局及相关影响因素。方法:回顾性分析2011年1月至2020年1月内蒙古医科大学附属医院诊治的54例单胎PCAA患者(PCAA组)的临床资料,选取同期62例产检健康的单胎妊娠孕妇作为对照组。比较两组分娩情况及母婴不良结局情况;根据PCAA孕妇不良结局分为结局不良组、非结局不良组,比较不同结局组孕妇临床资料,采用多因素Logistic回归分析影响因素。结果:54例PCAA孕妇中,有35例(64.81%)接受孕期输血治疗;胎死宫内2例,52例患者活产分娩中新生儿死亡2例,存活新生儿出生体重1 520~3 780 (2 741.56±598.47) g。PCAA组孕妇分娩孕周小于对照组、剖宫产率大于对照组(P<0.05);PCAA组重度子痫前期、妊娠期高血压疾病、产后出血、早产发生率(12.96%、16.67%、11.11%、25.93%)高于对照组(1.61%、3.23%、1.61%、8.06%)(P<0.05)。PCAA孕妇共22例(40.74%)发生不良结局;多因素Logistic回归分析显示:血小板计数<10×109/L(OR=4.834,95%CI:1.246~18.753)、血红蛋白<70 g/L(OR=5.639,95%CI:1.453~21.892)是PCAA孕妇母婴结局不良的危险因素(P<0.05),重型再生障碍性贫血(OR=2.017,95%CI:0.545~7.464)非PCAA孕妇母婴结局不良的危险因素(P>0.05)。结论:单胎PCAA患者母婴结局不良发生率相对高,血小板计数<10×109/L、血红蛋白<70 g/L的PCAA患者发生不良母婴结局的危险性更大。

Objective:To explore the maternal and infant outcomes of singleton pregnancy complicated with aplastic anemia(PCAA)and the related influencing factors.Methods::The clinical data of 54 single⁃ton PCAA patients(PCAA group)diagnosed and treated in Affiliated Hospital of Inner Mongolia Medical University from January 2011 to January 2020 were retrospectively analyzed,and 62 healthy singleton pregnant women during the same period were selected as the control group.The two⁃component delivery conditions and adverse maternal and infant outcomes were compared;accord⁃ing to the adverse outcomes of PCAA pregnant women,they were divided into poor outcome group and non⁃adverse outcome group.The clinical data of pregnant women in different outcome groups were compared,and the influencing factors were analyzed by multivariate logistic regression.Results::Among the 54 cases of PCAA pregnant women,35 cases(64.81%)received blood transfusion during pregnancy,and there were 2 cases of fetal death in utero and 2 cases of neonatal death.The birth weight of surviving newborns was 1520⁃3780 g,with an average of(2741.56±598.47)g.The ges⁃tational weeks of pregnant women in the PCAA group were less,and the cesarean section rate was higher than that respectively in the control group(P<0.05).The incidence of severe preeclampsia,hypertension in pregnancy,postpartum hemorrhage,and premature delivery(12.96%,16.67%,11.11%,and 25.93%,respectively)in the PCAA group was higher than in the control group(1.61%,3.23%,1.61%,and 8.06%,respectively;P<0.05).A total of 22 cases(40.74%)of pregnant women with PCAA had adverse outcomes;multivariate logistic regression analysis showed that platelet count<10×109/L(OR=4.834,95%CI:1.246⁃18.753)and hemoglobin<70 g/L(OR=5.639,95%CI:1.453⁃21.892)were risk factors for poor maternal and infant outcomes in PCAA pregnant women(P<0.05),while severe aplastic anemia(OR=2.017,95%CI:0.545⁃7.464)was not a risk factor for poor maternal and infant outcomes in pregnant women with PCAA(P>0.05).Conclusion::The incidence of adverse maternal and infant outcomes in singleton PCAA patients is rel⁃atively high.PCAA patients with platelet counts<10×109/L and hemoglobin<70 g/L are at great⁃er risk for adverse maternal and infant outcomes.