妊娠合并白血病孕妇及其新生儿的结局  

Outcomes in pregnant women with leukemia and their offsprings

作　　者：李洋洋[1] 刘捷[1] 曾超美[1] 秦炯[1] Li Yangyang;Liu Jie;Zeng Chaomei;Qin Jiong(Department of Pediatrics,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院儿科,北京100044

出　　处：《中华围产医学杂志》2023年第5期411-415,共5页Chinese Journal of Perinatal Medicine

基　　金：北京市临床重点专科项目(2199000726)。

摘　　要：目的分析合并白血病的孕产妇及其新生儿的结局。方法回顾性分析2009年6月至2021年5月北京大学人民医院收治的合并白血病的单胎孕产妇新生儿的临床资料。采用两样本t检验、Wilcoxon Mann-Whitney秩和检验、χ^(2)检验(或Fisher精确概率法)进行统计学分析。结果(1)91例患者纳入研究,占同期分娩量的2.8‰。91例中,急性淋巴细胞白血病15例(16.5%),急性髓系白血病38例(41.8%),慢性粒细胞白血病38例(41.8%)。29例(31.9%)于孕中、晚期引产,62例(68.1%)妊娠至分娩。62例产妇年龄(30.1±5.0)岁,其中2例于产后7 d内因白血病并发症死亡,5例产后转入重症监护病房。62例中,18例(29.0%)孕期有输血史,12例(19.3%)孕期应用了化疗药物。(2)引产孕妇中,孕期白血病未完全缓解或新发白血病的比例高于选择继续妊娠至分娩者[96.6%(28/29)与54.8%(34/62),χ^(2)=15.83,P<0.001]。(3)62例新生儿出生胎龄(37.7±2.7)周,其中早产18例(29.0%),低出生体重儿16例(25.8%),小于胎龄儿8例(12.9%)。10例(16.1%)新生儿发生高胆红素血症,2例(3.2%)发生新生儿低血糖。13例(21.0%)发生围产期缺氧窒息。4例(6.4%)存在外观或脏器畸形或染色体异常,这4例患儿母亲孕期均未使用化疗药物。59例生后3 d内完善血常规的患儿白细胞计数平均(16.1±7.0)×10^(9)/L,血红蛋白浓度平均(181.5±20.0)g/L,血小板计数平均(266.2±63.7)×10^(9)/L,外周血均未见幼稚细胞。20例获随访的儿童年龄4岁4个月(9个月~10岁3个月),生长发育均处于正常范围,未发现智力、运动等异常或血液系统疾病。结论妊娠合并白血病罕见且凶险,临床上需在治疗白血病基础上制定个体化治疗方案。合适的治疗方案仍有望获得良好的预后。Objective To analyze the maternal and neonatal outcomes of pregnant women with leukemia.Methods This retrospective study analyzed the clinical data of singleton pregnant women with leukemia and their neonates at the Obstetrics Department of Peking University People's Hospital from June 2009 to May 2021.Statistical analysis was performed using a two-sample t-test,the Wilcoxon Mann-Whitney rank sum test,and the Chi-square test(or Fisher's exact test).Results(1)Ninety-one pregnant women were enrolled in this study,accounting for 2.8‰of all deliveries during the same period.Among them,there were 15(16.5%)with acute lymphoblastic leukemia,38(41.8%)with acute myeloid leukemia,and 38(41.8%)with chronic myelogenous leukemia.Twenty-nine of the 91 pregnancies(31.9%)were terminated in the second or third trimester,and 62 babies(68.1%)were born through spontaneous delivery or cesarean section.The 62 parturients were(30.1±5.0)years old,of whom two died of complications of leukemia within 7 d after delivery,and five were transferred to the intensive care unit after delivery.Of the 62 cases,18(29.0%)received a blood transfusion and 12(19.3%)received chemotherapy during pregnancy.(2)The proportion of patients with unremitted leukemia during pregnancy or newly developed leukemia was higher in women with terminated pregnancy than in those who continued the pregnancy[96.6%(28/29)vs 54.8%(34/62),χ^(2)=15.83,P<0.001].(3)The gestational age of the 62 newborns was(37.7±2.7)weeks.Premature,low birth weight and small-for-gestational-age infants accounted for 29.0%(18/62),25.8%(16/62),and 12.9%(8/62),respectively.Hyperbilirubinemia occurred in 10 neonates(16.1%)and hypoglycemia in two(3.2%).Perinatal anoxia and asphyxia were reported in 13 cases(21.0%).Appearance,organ malformations,or chromosomal abnormalities were found in four neonates(6.4%)whose mothers did not receive chemotherapy during pregnancy.Fifty-nine infants underwent routine blood tests within 3 d after birth.The results showed that the mean white blood cell count,hemog

关 键 词：白血病 妊娠并发症 肿瘤 妊娠结局 婴儿 新生 生长和发育 

分 类 号：R714.2[医药卫生—妇产科学] R733.7[医药卫生—临床医学]