妊娠相关性血小板减少症的临床研究

Clinical study of pregnancy associated thrombocytopenia

摘要:

目的：探讨妊娠相关性血小板减少症（pregnancy associated thrombocytopenia，PAT）孕妇的凝血功能及血小板功能，PAT孕妇血小板减少程度与产后出血及围生儿结局的关系。方法：前瞻性分析2012年9月-2012年12月我院住院分娩的PAT患者41例临床资料，检测其凝血象、血小板功能，测量产时出血量、产后出血量及新生儿体质量。根据PAT孕妇血小板计数值分为3组：组1，血小板（80～99）×109个/L；组2血小板为（50～79）×109个/L；组3血小板＜50×109个/L。结果：PAT孕妇与正常对照组比较，凝血酶原时间、活化的部分凝血活酶时间和血小板聚集异常率差异均无统计学意义（P ＞0.05）。剖宫产分娩者中，重度血小板减少组（组3）产后出血量显著高于中度血小板减少组（组2）和轻度血小板减少组（组1），差异有统计学意义（P＜0.05）。新生儿体质量与孕妇血小板值之间无明显相关性，相关系数r＝0.18（P ＞0.05）。结论：不同程度的PAT孕妇凝血功能及血小板功能均为正常。轻、中度血小板孕妇发生产后出血的风险并不高于正常孕妇，但是重度PAT孕妇更容易发生产后出血。PAT孕妇血小板减少程度不影响围生儿结局。

Abstract:

Objective：To investigate the thrombin function and platelet function of woman with pregnancy associated thrombocytopenia （PAT） and the correlation between platelet count and postpartum hemorrhage and perinatal outcome. Methods：Clinical data of 41 cases of PAT women who delivered in our hospital from September 2012 to December 2012 were analyzed prospectively. Thrombin function，platelet function，volume of bleeding in delivery，occurrence rate of postpartum hemorrhage and birth weight of the newborns were included. All women with PAT were divided into 3 groups as below：group 1 with platelet count of （80-99）×109/L，group 2 with platelet count of （50-79）×109/L and group 3 with platelet count below 50×109/L. Results：There was no significant difference in pro－thrombin time，activated partial thromboplastin time and abnormity rates of platelet aggregation between normal control group and PAT women groups（P ＞0.05）. Volume of bleeding was higher in group 3 than in group 2 and group 1，with significant differences（P＜0.05）. Coefficient of correlation（r） between the weight of the newborns and platelet count was 0.18（P ＞0.05）. Conclusions：Thrombin func－tion and platelet function of PAT women are not affected by platelet count. Risk of postpartum hemorrhage is not higher in mild and middle grade PAT women than in normal pregnant women，but severe PAT women have higher risk of postpartum hemorrhage.De－creasing degree of platelet in PAT women will not affect perinatal outcome.