探究妊娠合并血小板减少患者产后血小板恢复的影响因素

To Explore the Influencing Factors of Platelet Recovery after Parturition in Pregnant Patients with Thrombocytopenia

摘要: 目的：分析不同病因妊娠合并血小板减少(PT)患者的一般临床资料，探究影响产后血小板恢复的因素。方法：回顾性分析146例PT患者的基本临床资料，根据产后血小板的恢复情况分组，比较其临床特征及淋巴细胞(L)的差异性，绘制受试者工作特征曲线，探讨L对产后血小板恢复的预测价值，分析影响产后血小板恢复的相关危险因素。结果：146例观察组中妊娠性血小板减少(GT) 90例(61.64%)，先兆子痫(PEC) 11例(7.53%)，CTD组13例(8.90%)，ITP组16例(10.96%)，其他组16例(10.96%)。随访统计产后6~8周的血常规，淋巴细胞的ROC曲线下面积为0.716 (95% CI 0.614~0.818)，L的截断值为1.8 × 10⁹/L。以1.8 × 10⁹/L为界，分为高淋巴细胞组及低淋巴细胞组，比较其临床特征，均无差异(P > 0.05)。对影响产后血小板恢复的临床特征进行单因素分析，L < 1.8 × 10⁹/L、产后出血(≥500 ml)、不同病因均可影响血小板的正常恢复(P < 0.05)；对上述四种情况进行多因素Logistic回归分析发现，ITP、L < 1.8 × 10⁹/L、产后出血(≥500 ml)是影响产后血小板恢复的独立危险因素(P < 0.05)。结论：ITP、较低的淋巴细胞计数、出血量 ≥ 500 ml预示产后血小板恢复不良。

Abstract: Objective: To analyze the general clinical data of patients with thrombocytopenia in pregnancy (PT) with different etiologies, and to explore the factors that affect the recovery of platelets after delivery. Methods: The basic clinical data of 146 patients with PT were retrospectively analyzed. Grouped according to the recovery of postpartum platelets, compared their clinical factors and the differences of lymphocytes (L), drawn receiver operating characteristic curve, explored the influence of L on the prognosis of postpartum platelets, and analyzed related risk factors affecting postpartum platelet recovery. Results: In the 146 observation group, 90 cases of gestational thrombocytopenia (GT) (61.64%), 11 cases (7.53%) of preeclampsia (PEC), 13 cases (8.90%) in the CTD group, 16 cases (10.96%) in the ITP group, 16 cases (10.96%) in other groups. Follow-up and statistics of routine blood test for 6 to 8 weeks after delivery, the area under the ROC curve of L was 0.716 (95% CI 0.614 to 0.818), and the cutoff value of L was 1.8 × 10⁹/L. Taking 1.8 × 10⁹/L as the boundary, they were divided into high lymphocyte group and low lymphocyte group, and compared their clinical characteristics, there was no difference (P > 0.05). Univariate analysis showed that the clinical features of postpartum platelet recovery were influenced by L < 1.8 × 10⁹/L, postpartum hemorrhage (≥500 ml) and different causes (P < 0.05). Logistic regression analysis showed that ITP, L < 1.8 × 10⁹/L and postpartum hemorrhage (≥500 ml) were independent risk factors affecting the recovery of postpartum platelets (P < 0.05). Conclusion: ITP, low lymphocyte count, bleeding ≥ 500 ml, and cesarean section indicate unfavorable prognosis of platelet after delivery.