妊娠合并慢性粒细胞性白血病患者的临床处理特点及妊娠结局分析  

Clinical analysis about the management and the perinatal outcomes of pregnancy with chronic myeloid leukemia

作　　者：王大鹏[1] 梁梅英[1] 张晓红[1] 王山米[1] 

机构地区：[1]北京大学人民医院产科,100044

出　　处：《中华妇产科杂志》2010年第10期735-739,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨妊娠合并慢性粒细胞性白血病（CML）患者的临床处理特点及妊娠结局.方法 1980年6月至2010年2月北京大学人民医院产科共收治妊娠合并CML 16例,采用回顾性分析的方法对妊娠合并CML患者的孕期特点、临床处理及妊娠结局进行分析.结果 （1）孕期临床处理及妊娠结局：16例妊娠合并CML患者中,9例经应用羟基脲或甲磺酸伊马替尼控制病情后,在孕早、中期终止妊娠;该9例患者就诊时平均孕周为7周（5～13周）,终止妊娠前、后对症输入红细胞纠正严重贫血,应用抗生素预防感染,未发生相关并发症.另7例妊娠至孕晚期分娩患者中,3例为孕前诊断CML,4例为孕期诊断CML.7例分娩患者就诊时平均孕周为36周（27～40周＋2）,孕期3例患者服用羟基脲,其中1例在用药过程中受孕,孕期仍继续用药.1例患者在孕40周入院后行白细胞单采术2次.1例行血小板单采术1次.3例未行任何治疗.孕期并发重度子痫前期3例（3/7）,其中2例口服羟基脲治疗.7例患者平均分娩孕周为38周（33周＋4～41周）,其中早产2例.分娩方式为剖宫产2例,阴道顺产3例,产钳助娩2例.有2例阴道顺产者发生产后出血,产后24 h出血量达1500～1800 ml,并引起继发性DIC.7例患者共分娩新生儿7例,新生儿平均出生体质量2469 g（1820～2810 g）.早产儿2例,低出生体质量儿2例,1例存在先天畸形,2例血常规检查异常.（2）产后治疗及预后随访：9例孕早、中期终止妊娠的患者中,失访4例;死亡1例,其病程3年;余4例随访5～72个月均存活,其中1例行骨髓移植术后治愈,2例坚持服用甲磺酸伊马替尼,1例服用羟基脲治疗.7例分娩的患者中,2例失访;2例死亡;3例存活.7例新生儿中2例失访,余5例随访4个月～9年,均生长发育正常.结论 妊娠合并CML并非为终止妊娠的绝对指征.孕期在严密监测病情变化的同时,选用相应的药物和（或）白细胞单采术治疗,监Objective To investigate the perinatal outcomes of pregnancy with chronic myeloid leukemia （CML） and how to manage it during pregnancy. Methods To retrospectively analyse the clinical datas about the perinatal outcome and the obstetric management of the 16 cases of pregnancy with CML during the last 30 years in a single center. Results （ 1 ） Management ang perinatal outcomes： among the 16 pregnancies nine ended with therapeutic abortion during the first or second trimester and no CML complications were observed. The average gestation week was 7 weeks（5 - 13 weeks）when they came to our hospital. Seven pregnancies gave birth, among which CML was diagnosed during pregnancy in four patients and pregnancy was confirmed during CML in three patients. The average gestation week was 36 weeks （27 -40 weeks ＋2）when they came to our hospital. Among the seven women three were treated with hydroxyurea （one became pregnant while she was on hydroxyurea and she elected to continue her pregnancy and continued to use hydroxyurea）, one with leukapheresis twice after her 40 weeks of gestation, one with plateletpheresis and three hadn＇t any treatment. In the seven pregnacies three developed severe preeclampsias, including the two had hydroxyurea during the gestation. The average delivery gestational week was 38 weeks （33 weeks ＋4 -41 weeks）, two were premature birth. Two caesarean sections, three vaginal deliveries and two forceps deliveries. There were two postpartum hemorrhage, during the 24 hours the amount of bleeding was 1500 - 1800 ml and secondary disseminated intravascular coagulation happened. Seven patients gave birth to seven infants whose average birth weight was 2469 g（ 1820 - 2810 g）, of whom two were premature infants, two low birth weight infants, one had congenital malformation and two had abnormal blood routine examinations. （2） Management after delivery and prognosis： during the nine patients who ended pregnancy with therapeutic abortion during the first or second trimester

关 键 词：妊娠并发症 肿瘤 白血病 髓系 慢性 BCR-ABL阳性 妊娠结局 

分 类 号：R686[医药卫生—骨科学]