妊娠合并血小板减少的病因及母婴结局分析

目的 探讨妊娠合并血小板减少（PT）的病因及母婴结局。方法 收集228例PT患者,其中血小板（51 ~ 100）×10⁹/L为轻度组,血小板（30 ~ 50）×10⁹/L为中度组,血小板< 30×10⁹/L为重度组,比较3组患者的病因和母婴结局的差异。结果 228例PT孕妇中,轻度血小板减少159例（69.8%）,中度血小板减少33例（14.5%）,重度血小板减少36例（15.8%）。主要病因有妊娠相关性血小板减少症（63.6%）、特发性血小板减少性紫癜（11.8%）、HELLP综合征（3.9%）、SLE（3.9%）和子痫前期-子痫（2.2%）。轻度组、中度组和重度组的妊娠丢失、早产、产后出血、新生儿血小板减少的发生率及分娩孕周比较差异均有统计学意义（P均< 0.05）,其中重度组的妊娠丢失率、早产率、产后出血率均高于轻度组,分娩孕周短于轻度组（P均< 0.017）。结论 PT的病因复杂多样,病因多见妊娠相关性血小板减少症、特发性血小板减少性紫癜、HELLP综合征、SLE和子痫前期-子痫。血小板< 30×10⁹/L的PT患者发生妊娠丢失、早产、产后出血的概率明显增加。

Etiology and maternal and infant outcomes of pregnancy complicated with thrombocytopenia

Objective To investigate the etiology and maternal and infant outcomes of pregnancy complicated with thrombocytopenia. Methods Clinical data of 228 pregnant women complicated with thrombocytopenia were collected. According to the platelet count during pregnancy, all patients were divided into the mild （（51-100）×10⁹/L）, moderate （（30-50）×10⁹/L） and severe thrombocytopenia groups （< 30×10⁹/L）, respectively. The etiology, and maternal and infant outcomes were statistically compared among three groups. Results Among 228 pregnancies complicated with thrombocytopenia, 159 patients （69.8%） presented with mild thrombocytopenia, 33 cases （14.5%） of moderate thrombocytopenia and 36 cases （15.8%） of severe thrombocytopenia. The etiology mainly included pregnancy-associated thrombocytopenia （63.6%）, idiopathic thrombocytopenic purpura （11.8%）, HELLP syndrome （3.9%）, systemic lupus erythematosus （3.9%） and preeclampsia and eclampsia （2.2%）. The incidence of fetal loss, preterm labor, postpartum hemorrhage, neonatal thrombocytopenia and gestational week significantly differed among three groups （all P < 0.05）. In the severe group, the incidence of fetal loss, preterm labor, postpartum hemorrhage and neonatal thrombocytopenia was significantly higher, whereas the gestational week was significantly shorter compared with those in the mild groups （all P < 0.017）. Conclusions The etiology of pregnancy complicated with thrombocytopenia is complex. The etiology primarily includes pregnancy-associated thrombocytopenia, idiopathic thrombocytopenic purpura,HELLP syndrome, SLE, preeclampsia and eclampsia. Patients with platelet count < 30×10⁹/L are more likely to have an increased incidence of fetal loss, preterm labor, postpartum hemorrhage, neonatal thrombocytopenia.