妊娠合并血小板减少的病因及母婴结局分析

Analysis of etiological composition and maternal and infant outcomes of thrombocytopenia in pregnancy

目的:探讨妊娠合并血小板减少的病因、临床特点、诊疗方案、母婴结局等,为临床早期精准识别、个性化治疗等提供有效依据。方法:收集2019年6月至2023年6月于郑州大学第一附属医院产科分娩的255例妊娠合并血小板减少产妇的临床资料,根据病因分类:妊娠期特发性血小板减少组(PAT组)、妊娠期高血压疾病相关性血小板减少组(HDCP组)、特发性血小板减少性紫癜组(ITP组)和其他组,比较各组的血小板减少程度、临床特点、治疗方案及母婴结局。结果:妊娠期血小板减少的病因主要为PAT、ITP、HDCP,其他病因较少见。4组患者的孕产次、体质量指数(BMI)比较,差异无统计学意义(P>0.05),ITP组年龄低于其他三个病因组,重度组年龄低于轻度组,差异有统计学意义(P<0.05)。PAT组、HDCP组中血小板减少主要为轻度,ITP组以及其他组重度占比更高(P<0.05);ITP组的出血事件、妊娠期输血及其他治疗措施较其他三组更多,各组间差异有统计学意义(P<0.05)。按不同方式分组,PAT组反应时间(R)在病因分组中最低,PAT组以及轻度组的凝固角(α)、最大振幅(MA)在各分组中最高,重度组与上述相反,差异有统计学意义(P<0.05)。PAT组的母婴结局相较于其他三组最好,ITP组因血小板减少导致的剖宫产、出血事件、住院期间输血小板占比最高,产时、术中出血量最多;HDCP组中的早产率及Apgar评分最低,各组差异有统计学意义(P<0.05)。结论:妊娠期血小板减少的病因不同,血小板减少的程度、临床特点以及母婴结局各有不同,PAT患者发病症状隐匿,血小板减少程度轻,出现时间晚;ITP患者的发现时间早,出血事件多,血小板减少程度重,HDCP介于两者之间。及时明确病因,合理规范化治疗是改善母婴结局的关键。

Objective:To investigate the etiology,clinical characteristics,diagnosis and treatment plans,maternal and infant outcomes of thrombocytopenia during pregnancy,so as to provide an effective basis for early clinical accurate identification and personalized treatment.Methods:The clinical data of 255 pregnant women with thrombocytopenia who delivered in the obstetrics department of the First Affiliated Hospital of Zhengzhou University from June 2019 to June 2023 were collected.According to the etiology,they were classified as pregnancy-associated thrombocytopenia(PAT),hypertensive disorder complicating pregnancy(HDCP),idiopathic thrombocytopenic purpura(ITP)and other groups.The degree of thrombocytopenia,clinical characteristics,treatment options and maternal and infant outcomes were compared among the groups.Results:The main causes of thrombocytopenia during pregnancy were PAT,ITP and HDCP,and other causes were rare.There was no significant difference in the number of pregnancies and births and body mass index among the four groups(P>0.05).The age of ITP group was lower than that of other three groups,the severe group was younger than the mild group,with statistically significant differences(P<0.05).The thrombocytopenia in PAT group and HDCP group was mainly mild,and the proportion of severe thrombocytopenia in ITP group and other groups was higher(P<0.05).There were more bleeding events,blood transfusion during pregnancy and other therapeutic measures in ITP group than in the other three groups,and the difference among all groups was statistically significant(P<0.05).According to different grouping methods,the coagulation reaction time(R)of the PAT group was the lowest in the group,and the coagulation angle(α),maximum amplitude(MA)of ITP group and mild group were the highest in each group.The severe group were opposite to the above,and the difference was statistically significant(P<0.05).Compared with the other three groups,the maternal and infant outcomes in the PAT group were the best.The ITP group had the highest cesarean section rate due to thrombocytopenia,bleeding events and the proportion of platelet transfusion during hospitalization,and the largest amount of blood loss during delivery and during operation.Preterm birth rate and Apgar score in HDCP group were the lowest,and the differences among all groups were statistically significant(P<0.05).Conclusion:The causes of thrombocytopenia during pregnancy are different.The degree of thrombocytopenia,clinical characteristics and maternal and infant outcomes are different.The onset symptoms of PAT patients are insidious,the degree of thrombocytopenia is mild,and the occurrence time is late.Patients with primary immune thrombocytopenia have early detection time,more bleeding events,and severe thrombocytopenia,the HDCP is in between.Timely identification of the cause and reasonable standardized treatment are the key to improving maternal and infant outcomes.