妊娠期血小板减少的病因及结局

Etiology and outcomes of gestational thrombocytopenia

目的探讨妊娠期血小板减少的病因及结局。方法回顾性分析2010-01至2016-12首都医科大学附属北京世纪坛医院收治的146例妊娠期血小板减少患者的临床资料,将146例患者分为3组,血小板计数> 50×10~9/L为Ⅰ组,血小板计数在(30～50)×10~9/L为Ⅱ组,血小板计数<30×10~9/L为Ⅲ组。寻找病因,有目的性治疗,Ⅰ组严密监测血小板计数。Ⅱ组及Ⅲ组,予糖皮质激素治疗,动态监测血小板计数。加强围产期监测和产后追访,进一步探求病因。结果妊娠期血小板减少的主要病因有妊娠相关性血小板减少症(pregnancy associated thrombocytopenia,PAT)、特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)、妊娠期合并症、内科合并症等,妊娠期血小板减少是自身免疫性疾病发生过程中的重要迹象之一;血小板计数<30×10~9/L者剖宫产率、输血小板率明显高于(30～50)×10~9/L者,明显高于> 50×10~9/L者(P <0. 05)。结论妊娠期血小板减少须尽量明确诊断,应视不同的病因、血小板减少的轻重程度及病情的缓急状况,而采取不同的治疗方式及选择不同的分娩方式,产后随访3年。

Objective To investigate the etiology and outcome of gestational thrombocytopenia. Methods The clinical data on 146 cases of gestational thrombocytopenia treated in Beijing Shijitan Hospital between January 2010 and December 2016 was retrospectively analyzed. These patients were divided into three groups: group Ⅰin which the platelet count was above 50 × 10~9/L,groupⅡ in which the platelet count was between( 30-50) ×10~9/L,and group Ⅲ whose platelet count was lower than 30 × 10~9/L. The cause of disease was explored in order to offer targeted treatment. The platelet count of group Ⅰ was monitored closely. Patients vulnerable to bleeding in groups Ⅱ and Ⅲ were treated with glucocorticoid and had their platelet count dynamically monitored. Importance was attached to perinatal surveillance and postpartum visits so as to find out more about the cause of disease. Results The main causes of gestational thrombocytopenia included pregnancy associated thrombocytopenia( PAT),idiopathic thrombocytopenic purpura( ITP) and pregnancy complications. Gestational thrombocytopenia was one of the most important signs of autoimmune diseases. Patients with platelet counts < 30 × 10~9/L had a significantly higher rate of cesarean section and platelet transfusion than those with platelet counts of( 30-50) × 10~9/L and( 50-100) × 10~9/L( P < 0. 05). Conclusions Clear diagnoses are required in case of gestational thrombocytopenia. Different treatment methods and different ways of delivery should be applied according to etiologies,severity of thrombocytopenia and degree of urgency. Follow-up should last for 3 years after delivery.