妊娠合并血小板减少与新生儿转归的分析

Thrombocytopenia in pregnancy and neonatal outcomes

摘要:

目的：探讨不同病因所致妊娠血小板减少与新生儿转归的关系。方法：选择2009年1月至2010年12月140例妊娠合并血小板减少的孕妇及其新生儿，孕妇根据血小板减少的病因分为4组：妊娠期血小板减少症（GT）组（n=94）；妊娠合并免疫性血小板减少性紫癜(ITP)组（n=30）；妊娠合并其他血液系统疾病（再障、骨髓增生异常综合征）组（n=12）；其他原因组（n=4）：妊娠期高血压综合征(PIH)、妊娠合并系统性红斑狼疮（SLE)、妊娠合并酒精性肝硬化等。比较4组新生儿的转归。结果：GT组早产率11.3%，ITP组早产率16.7%，两组比较差异无统计学意义（P>0.05）。妊娠合并其他血液系统疾病组早产率53.8%，明显高于GT组（P<0.01）和ITP组（P<0.05）。GT组和ITP组中分别有 2例（2%）和4例（13%）患新生儿先天性被动免疫性血小板减少症，其发生比率差异有统计学意义(P<0.05)。ITP组中1例（3%）患ITP，1例（3%）患Evans综合征。妊娠合并其他血液系统疾病组1例（8%）患颅内出血。其他原因组中1例（25%）患新生儿狼疮综合征。结论：不同病因所致妊娠期血小板减少可致不同的围产期母婴结局。

Abstract:

OBJECTIVE: To study the relationship between thrombocytopenia in pregnancy associated with various causes and neonatal outcomes. METHODS: Medical records of 140 pregnant women with thrombocytopenia in pregnancy and the neonatal outcomes from January 2009 to December 2010 were reviewed retrospectively. The pregnant women were classified into four groups according to the causes of thrombocytopenia: gestational thrombocytopenia (GT; n=94), pregnancy with immune thrombocytopenic purpura (ITP; n=30), pregnancy with other hematological disease (aplastic anemia or myelodysplastic syndrome; n=12), and other causes (n=4): pregnancy induced hypertension syndrome, pregnancy with systemic lupus erythematosus, and pregnancy with alcoholic cirrhosis. The neonatal outcomes in the four groups were compared. RESULTS: The premature birth rates in the GT and the ITP groups were 11.3% and 16.7%, respectively. There was no significant difference between the two groups. The premature birth rate in the other hematological disease group was 53.8%, which was significantly higher than that in the GT (P<0.01) and the ITP groups (P<0.05). Congenital passive immune thrombocytopenia was found in 2 neonates (2%) in the GT group and in 4 neonates (13%) in the ITP group (P<0.05). In addition, other diseases were also observed in neonates in the ITP group, including 1 case (3%) of ITP and 1 case (3%) of Evans syndrome. Intracranial hemorrhage occurred in one neonate (8%) in the other hematological disease group. Neonatal lupus syndrome was found in 1 case (25%) in the other causes group. CONCLUSIONS: Thrombocytopenia in pregnancy associated with different causes may result in different neonatal outcomes.