妊娠合并重度血小板减少37例临床分析

摘要

Objective: To study the etiology and its influence on the mother and infant of severe pregnancy thrombocytopenia.Methods: The clinical data of 37 cases of severe pregnancy thrombocytopenia were analyzed retrospectively. The cases were divided into two groups according to the causes of the disease. The cases with pregnancy-associated thrombocytopenia(PAT) were enrolled in group Ⅰ and the cases with idiopathic thrombocytopenic purpura( ITP), aplastic anemia, HELLP syndrome and myelodysplasia(MDS-RA) in group Ⅱ. The outcome was compared between the two groups. Results:Twenty-three cases(62.3％ ) of severe thrombocytopenia during pregnancy were caused by PAT,and 9 cases(24.32％ ) were caused by ITP. The incidence of postpartum hemorrhage in group Ⅱ was markedly higher than that in group Ⅰ ( P ＜ 0.05 ). The neonate's average birth weight in group I was higher than that in group Ⅱ , and the average gestational age of group I was senior to that of group Ⅱ ( P ＜ 0.05 - P ＜ 0.01 ). The platelet counts in group Ⅰ recovered more quickly than that in group Ⅱ 10 days after the operation(P ＜ 0.01 ). Conclusions:The major causes of severe thrombocytopenia during pregnancy are PAT and ITP;however,the patients suffering from PAT have a better outcome.%目的:探讨妊娠合并重度血小板减少的病因及对母婴的影响.方法:对37例妊娠合并重度血小板减少的孕妇,根据病因、妊娠相关血小板减少症(PAT)为Ⅰ组,妊娠合并再生障碍性贫血、特发性血小板减少性紫癜(ITP)、骨髓增生异常综合征RA型(MDS-RA)及HELLP综合征为Ⅱ组,观察2组的妊娠结局.结果:37例孕妇中PAT 23例(62.16%),ITP 9例(24.32%);Ⅱ组产后出血率高于Ⅰ组(P<0.05);Ⅰ组新生儿出生体重、胎龄均大于Ⅱ组(P<0.05～P<0.01);术后10天Ⅰ组产妇血小板恢复优于Ⅱ组(P<0.01).结论:妊娠合并重度血小板减少病因以PAT为主;其次为ITP.由PAT引起的重度血小板减少患者妊娠结局较好.