早产儿血小板减少症的临床特征及结局分析

Clinical Characteristics and Outcome Analysis of Premature Infants with Thrombocytopenia

摘要: 目的：回顾性分析早产儿血小板减少症的临床资料，探讨早产儿血小板减少症的临床特征及转归，分析血小板的输注对其临床结局的影响。方法：选择2017年1月至2018年12月出生的194例血小板减少(血小板 < 150 × 109/L)早产儿为研究对象，依据血小板减少严重程度分为轻度血小板减少组(血小板100 × 109/L~150 × 109/L)、中度血小板减少组(血小板50 × 109/L~99 × 109/L)及重度血小板减少组(血小板小于50 × 109/L)。按照胎龄分为胎龄 < 34周组、胎龄 ≥ 34周组。按照发病日龄分为早发型血小板减少组(发病 < 3天)和晚发型血小板减少组(发病 ≥ 3天)。比较患儿母孕期情况、患儿出生情况、临床特点及转归，分析血小板减少病因及血小板的输注对临床结局的影响。结果：早产儿血小板减少首要病因为围产期因素，约占43.8%；晚发型血小板减少组的败血症(P = 0.000)和NEC (P = 0.033)比例明显高于早发型血小板减少组；NEC在血小板重度减少组所占比例较轻、中度血小板减少组明显增加(P = 0.000)；重度血小板减少组的早产儿容易发生重度出血(P = 0.000)，血小板输注后重度出血仍较高(P = 0.000)。结论：1) 早产儿血小板减少病因以围产期因素多见，可以导致不同程度的血小板减少。2) 败血症、NEC是晚发型血小板减少的重要病因。NEC导致血小板减少的程度一般较重。3) 重度血小板减少的出血情况比较严重，输注血小板后没有减少严重出血。

Abstract: Objective: To retrospectively analyze the clinical data of premature infants with thrombocytopenia, explore the clinical characteristics and prognosis of premature infants with thrombocytopenia, and analyze the effect of platelet transfusion on its clinical outcome. Methods: A total of 194 premature infants with thrombocytopenia (thrombocytopenia < 150 × 109/L) born from January 2017 to December 2018 were selected as the study subjects. According to the severity of thrombocytopenia, they were divided into the mild thrombocytopenia group (thrombocytopenia 100 × 109/L~150 × 109/L), the moderate thrombocytopenia group (thrombocytopenia 50 × 109/L~99 × 109/L) and the severe thrombocytopenia group (thrombocytopenia less than 50 × 109/L). According to gestational age, they were divided into the gestational age < 34 weeks group and the gestational age ≥ 34 weeks group. According to the onset age, they were divided into the early onset group (onset < 3 days) and the late onset group (onset ≥ 3 days). The pregnancy, birth, clinical characteristics and outcomes of the mothers of the children were compared, and the causes of thrombocytopenia and the effects of platelet transfusion on clinical outcomes were analyzed. Results: The primary cause of thrombocytopenia in premature infants was perinatal factors, accounting for 43.8%; The proportion of sepsis (P = 0.000) and NEC (P = 0.033) in late onset thrombocytopenia group was significantly higher than that in early onset thrombocytopenia group; The proportion of NEC was higher in the severe thrombocytopenia group (P = 0.00); Premature infants in the severe thrombocytopenia group were prone to severe bleeding (P = 0.000), and severe bleeding was still higher after platelet transfusion (P = 0.000). Conclusion: 1) The causes of thrombocytopenia in premature infants were mostly perinatal factors, which could lead to thrombocytopenia in different degrees. 2) Sepsis and NEC are important causes of late onset thrombocytopenia. NEC often results in severe thrombocytopenia. 3) Severe thrombocytopenia has severe bleeding, and platelet transfusion doesn’t reduce severe bleeding.