妊娠相关血小板减少症和妊娠合并特发性血小板减少性紫癜的对比探

【摘要】目的  探讨妊娠相关血小板减少症(PAT)和妊娠合并特发性血小板减少性紫癜(PCITP)的鉴别，寻找最佳的处理方法。 方法  对在成都市青羊区妇幼保健院2000年1月至2010年12月收治的妊娠相关血小板减少症和妊娠合并特发性血小板减少性紫癜69例进行回顾性分析，对其发生时期、处理方法、妊娠结局进行回顾性分析。结果   PAT一般发生在妊娠中晚期。血小板计数多大于50×109/l,多在产后一周恢复正常。一般不需要特殊处理。PCITP多发生在孕前和妊娠早期，血小板减小程度较重，PCITP组剖宫产率和产后出血率较PAT组均有显著差异，血小板小于50×109/l，有明显出血倾向或紧急手术前，可输血小板。分娩方式视血小板多少有无产科指征而定。结论  ATP和PCITP各有其特点，不同病因可导致妊娠合并血小板减少，视血小板减少的轻重程度而采取不同处理。
【关键词】妊娠相关血小板减少症  妊娠合并特发性血小板减少性紫癜
【Abstract】objective: The objective of this research is to explore the identification of pregnancy associated thrombocytopenia (PAT )and pregnancy complicated with idiopathic thrombocytopenic purpura (PCITP) ,and to find optimum treatment.Methods: clinical data of 69 cases of pregnancy associated thrombocytopenia and pregnancy complicated with idiopathic thrombocytopenic purpura were retrospectively reviewed during January 2000 to December 2010 Chengdu Qingyang District Maternal and Child Health Hospital.The term of occurrence of thrombocytopenia as well as treatment methods of thrombocytopenia and outcomes of pregnancy were analyzed retrospectively.Results: PAT usually occurs in late pregnancy,platelet cout is usually more than 50 X 109/l and recovered to normal in one week after delivery.PAT generally do not need special treatment.PCITP occurs before being pregnant and the pregnancy early time ,the blood platelet reduction degree is heavy.cesarean sectio reate and the post portum hemorrhage rate in the PCITP group compare with of PAT group have remarkable difference.platelet was given to those with platelat count less than 50X109/l for obvious bleeding tendency or emergency operation.The method of delivery depended on platelet number and obstetric indication.Conclusion: PAT and PCITP have respective charateristics.The various cause may lead thrombocytopenia whih pregnancy.The different management is given in according to different etiology.
【Key words】pregnancy associated thrombocytopenia; pregnancy complicated with idiopathic thrombocytopenic purpura
        妊娠合并血小板减少对母婴危害较大。该病以出血、贫血和感染为特点，可导致产后出血、新生儿颅内出血等。血小板减少在妊娠中的发生率为7.6%，其中妊娠相关血小板减少症(pregnancy associated thrombocytopenia ,PAT )和妊娠合并特发性血小板减少性紫癜(pregnancy complicated with idiopathic thrombocytopenic purpura ,PCITP)发生率最高。为此，本文回顾性分析2005-2010年收治的PAT和PCITP 69例的临床资料，现报道如下：
        1 临床资料
        1.1 收集2005年1月至2010年12月在成都市青羊区妇幼保健院住院的妊娠合并血小板减少性紫癜患者69例，年龄20-38岁，平均28.2岁，孕周33-42周，平均38.2周。PCITP患者18例，年龄21-34岁，平均年龄27.3岁。