免疫性血小板减少症妊娠期治疗相关并发症研究  

Research of the treatment-related complications of pregnany with immune thrombocytopenia

作　　者：陈哲[1] 梁梅英[1] 徐雪[1] 窦莎 张晓红[1] 王建六[1] 

机构地区：[1]北京大学人民医院妇产科,100044

出　　处：《中国妇产科临床杂志》2017年第6期515-519,共5页Chinese Journal of Clinical Obstetrics and Gynecology

摘　　要：目的探讨妊娠期免疫性血小板减少症(immune thrombocytopenia,ITP)母体干预治疗对母儿并发症及妊娠结局的影响。方法选择2009年1月到2016年1月北京大学人民医院产科收治的血小板计数有两次或以上<30×10~9/L妊娠期ITP 119例,给予系统孕期保健,根据不同治疗方法分为单独糖皮质激素组(33例)、丙种球蛋白组(8例)、激素联合丙球组(26例)和支持治疗组(52例)4组。比较各组相关母体并发症、分娩结局、新生儿和随访情况。结果 119例患者中,糖皮质激素治疗开始孕周20~35孕周,用药时间1~15周。丙种球蛋白治疗开始孕周16~36周,周期1~5个疗程。妊娠期高血压疾病(HDP)13例(10.9%),妊娠期糖尿病(GDM)18例(15.1%),贫血39例(32.8%),早产24例(20.2%),胎膜早破8例(6.7%);产后出血33例(27.7%),产褥感染1例(0.8%),无重要脏器自发出血及孕产妇死亡。4组在HDP与早产的发生率比较,差异有统计学意义(P<0.05)。激素治疗组与无激素治疗组HDP、GDM和早产发生率比较,差异有统计学意义(P<0.05),但两组<36周早产率比较,差异无统计学意义(P>0.05)。终止妊娠孕周30^(+6)~40^(+5)周。剖宫产76例(63.9%)。围生儿119例,活产儿116例,死胎3例:无死产及新生儿死亡。新生儿血小板减低16例(13.4%),头颅血肿1例。结论妊娠期ITP患者经合理干预可获得满意妊娠结局。激素治疗可导致HDP、GDM等相关并发症增加,应注意适应证及监测母体血压、血糖变化。Objective To investigate the gestational treatment-related complications and the perinatal outcomes of pregnancies with immune thrombocytopenia （ITP）. Methods A retrospective study was conducted on clinical data of 119 perinatal pregnancies with ITP, who admitted to PKU People＇s Hospital from January 2009 to January 2016. All the patients had systemic antenatal care and definite etiological diagnosis of ITP, with platelet counts less than 30 × 109/L at least twice during pregnancy and complete follow-up. The subjects were divided into 4 groups according to different kinds of treatment： group I （33 cases）： single glucocorticoid therapy, group II （8 cases）： single immunoglobin therapy, group III （26 cases）： glucocorticoid and immunoglobin therapy, group IV （52 cases）： supportive treatment. Datas of gestational treatments, pregnancy complications, delivery outcomes, neonates outcomes and the follow-up results of each group were recorded and compared. Results ① The treatment initiate times of glucocorticoid therapy were 20 ~ 35 gestational weeks, medication time were 1- 15 weeks. The treatment initiate times of immunoglobin therapy were 16~36 gestational weeks, medication time were 1 ~5 courses. ② Maternal complications： Hypertensive disorder complicating pregnancy （HDP） was diagnosed in 13 cases （10.9%）, gestational diabetes mellitus （GDM） 18 cases （15.1%）, anemia 39 cases （32.8%）, preterm delivery 24 cases （20.2%）, premature rupture of membranes （PROM） 8 cases（6.7%）. The delivery weeks were 30＋6 to 40＋5 weeks （average 36 weeks）. 43 cases （36.1%） underwent vaginal delivery, 76 cases （63.9%） cesarean section. Postpartum hemorrhage （PPH） was observed in 33 cases （27.7%）, puerperal infection 1 case （0.8%）, no maternal death. There were significant differences of the mobidity of HDP, GDM and preterm delivery between the group treated with glucocorticoid and without it （P〈 0.05） .But there was no significant differenc

关 键 词：免疫性血小板减少症 妊娠 治疗 并发症 妊娠预后 

分 类 号：R714.254[医药卫生—妇产科学]