妊娠期血小板计数 - NEJM医学前沿
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妊娠期血小板计数
Platelet Counts during Pregnancy


Jessica A. Reese ... 围产医学和儿科 • 2018.07.05
相关阅读
• 注意妊娠期低血小板计数

摘要


背景

如果未发现血小板减少的其他原因,无并发症的妊娠期间血小板计数低于150,000/mm3被称作妊娠期血小板减少症。在有妊娠相关并发症的女性中,血小板计数甚至可能更低。然而,整个妊娠期间血小板减少症的发生率和严重程度尚未确定。

 

方法

我们评价了2011—2014年,在俄克拉何马大学医疗中心分娩女性的妊娠期血小板计数。将这些血小板计数与1999—2012年美国全国健康与营养调查(National Health and Nutrition Examination Survey,NHANES)中纳入的未妊娠女性的血小板计数进行了比较。

 

结果

在研究期间发生的15,723例分娩中,7,351例女性有充分数据可用于分析。在这些女性中,4,568例的妊娠无并发症,2,586例有妊娠相关并发症,197例原有血小板减少性疾病。在无并发症的妊娠女性中,妊娠早期(平均妊娠8.7周)的平均血小板计数为251,000/mm3,这比8,885例未妊娠女性的平均血小板计数(273,000/mm3)低(P<0.001)。分娩时,9.9%无并发症的妊娠女性的血小板计数低于150,000/mm3。在无并发症的妊娠和分娩期间,仅45例女性(1.0%)的血小板计数低于100,000/mm3。在12例血小板计数低于80,000/mm3的无并发症的妊娠女性中,仅5例(0.1%,她们的血小板计数范围为62,000~78,000/mm3;中位数,65,000)通过病历复查确定没有血小板减少的其他原因。与无并发症的妊娠女性相比,在有妊娠相关并发症的女性中,分娩时血小板计数低于150,000/mm3较常见(11.9% vs. 9.9%,P=0.01)。在妊娠和分娩期间,59例有妊娠相关并发症的女性(2.3%)的血小板计数低于100,000/mm3,31例(1.2%)的血小板计数低于80,000/mm3

 

结论

从妊娠早期开始,在妊娠期间所有女性的平均血小板计数减少。在血小板计数低于100,000/mm3的女性中,应考虑妊娠之外的原因或妊娠并发症(由美国国立心肺和血液研究所[National Heart, Lung, and Blood Institute]资助)。





作者信息

Jessica A. Reese, Ph.D., Jennifer D. Peck, Ph.D., David R. Deschamps, M.D., Jennifer J. McIntosh, D.O., Eric J. Knudtson, M.D., Deirdra R. Terrell, Ph.D., Sara K. Vesely, Ph.D., and James N. George, M.D.
From the Department of Biostatistics and Epidemiology, College of Public Health (J.A.R., J.D.P., D.R.T., S.K.V., J.N.G.), the Hematology–Oncology Section, Department of Medicine, College of Medicine (J.A.R., J.N.G.), and the Maternal–Fetal Medicine Section, Department of Obstetrics and Gynecology, College of Medicine (D.R.D., J.J.M., E.J.K.), University of Oklahoma Health Sciences Center, Oklahoma City. Address reprint requests to Dr. George at the College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., Oklahoma City, OK 73104, or at james-george@ouhsc.edu. Eric J. Knudtson, M.D., is deceased.

 

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