妊娠期原发免疫性血小板减少症  

Primary Immune Thrombocytopenia in Pregnancy

作　　者：高月华 李洁[2] 苏婧[2] 孙艳[2] 李增彦[2] GAO Yue-hua;LI Jie;SU Jing;SUN Yan;LI Zeng-yan(Department of Obstetrics and Gynecology,Guangdong Maternal and Child Health Hospital,Guangzhou 511442,China;Department of Obstetrics and Gynecology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]广东省妇幼保健院妇产科,广州511442 [2]天津医科大学总医院妇产科

出　　处：《国际妇产科学杂志》2022年第1期60-66,共7页Journal of International Obstetrics and Gynecology

基　　金：天津市卫生计生委科技基金(16KG121)。

摘　　要：原发免疫性血小板减少症(primary immune thrombocytopenia,ITP)是一种获得性自身免疫性疾病,也是妊娠早期血小板计数低于50×10^(9)/L的最常见原因。目前认为抗血小板自身抗体的产生、T细胞介导的血小板破坏增多及血小板凋亡在ITP的发病中有重要作用。ITP症状隐匿,分类和鉴别诊断复杂,与妊娠期血小板减少症的临床表现相似极易混淆,临床工作中最需与其相鉴别。妊娠期ITP缺少规范的诊疗实践,但其原则应是强调孕前咨询的重要性,在继续妊娠的风险与预防性的产前治疗中,寻求良好的平衡点,关注孕妇血小板变化趋势及临床表现,将血小板计数提高到安全范围而不是正常范围内,避免过度治疗。治疗方案包括紧急治疗、一线治疗与二线治疗。发生临床出血(如难以控制的活动性出血及重要脏器的自发性出血)或处于围手术期时应尽快将患者血小板计数提高至50×109/L以上。一线治疗方案包括醋酸泼尼松和丙种球蛋白,可单独使用也可联合使用;二线治疗方案在妊娠期开展受限。Primary immune thrombocytopenia(ITP)is an acquired autoimmune disease and the most common cause of platelet counts below 50×109/L in early pregnancy.At present,it is believed that the production of anti-platelet autoantibodies,increased platelet destruction mediated by T cells and platelet apoptosis play an important role in the pathogenesis.ITP during pregnancy lacks specific symptoms and signs,the classifications and differential diagnoses are complicated.It is very easy to be confused with gestational thrombocytopenia,so it is the most necessary to differentiate with it in the clinical practice.ITP during pregnancy lacks standardized diagnostic practice,but the principle should be to emphasize the importance of pre-pregnancy consultation,to strike a perfect balance between the risks of continuing the pregnancy and preventive prenatal intervention,to pay attention to the maternal platelet changes and clinical manifestations,to raise the platelet count to a safe rather than normal range,and to avoid overtreatments.Treatment options include emergency treatment,first-line treatment,and second-line treatment.In patients with clinical bleeding,such as unmanageable active bleeding and spontaneous bleeding of vital organs,and in perioperative period,the platelet count should be increased to above 50×109/L as soon as possible;first-line treatments include prednisone acetate and intravenous immunoglobulin,which can be used alone or in combinations,second-line treatments are limited during pregnancy.

关 键 词：紫癜 血小板减少性 特发性 血小板减少 妊娠并发症 血小板减少 新生儿同种免疫性 糖皮质激素类 免疫球蛋白类 

分 类 号：R714.254[医药卫生—妇产科学]