临床儿科杂志 ›› 2019, Vol. 37 ›› Issue (11): 866-.doi: 10.3969/j.issn.1000-3606.2019.11.017

• 综合报道 • 上一篇    下一篇

极低出生体质量儿血小板减少症51 例临床分析

肖佳荔,黄华飞,周庆女,陈建飞   

  1. 嘉兴市妇幼保健院(浙江嘉兴 314001)
  • 出版日期:2019-11-15 发布日期:2020-02-03
  • 通讯作者: 黄华飞 电子信箱:xzyc71@163.com
  • 基金资助:
    嘉兴市科技计划项目(No.2017AY33039)

Clinical analysis of thrombocytopenia in 51 cases of very low birth weight infants

 XIAO Jiali, HUANG Huafei, ZHOU Qingnü, CHEN Jianfei   

  1. Jiaxing Maternity and Child Health Care Hospital, Jiaxing 314001, Zhejiang, China
  • Online:2019-11-15 Published:2020-02-03

摘要:  目的 探讨极低出生体质量儿血小板减少的原因和临床特点。方法 回顾分析2013年1月至2016年12月收 治的51例极低出生体质量儿血小板减少症患儿的临床资料。结果 51例患儿中,男31例,女20例,胎龄为25+4周~36+1周, 中位出生体质量(1285±207.9) g;血小板减少平均发病日龄为(11.84±13.16)天,以晚发型为主,占39例(76.5%)。39 例晚发型患儿的主要发病原因,感染占26例(66.7%);早发型患儿的发病原因,窒息5例、母亲妊娠高血压综合征4例、胎 儿宫内发育迟缓4例(1例同时存在母亲妊娠高血压综合征及宫内发育迟缓, 1例同时存在窒息、母亲妊娠高血压综合征及 宫内发育迟缓)。51例患儿中仅有实验室异常无出血征象者31例(60.9%,早发型8例、晚发型23例),颅内出血13例(25.4%, 早发型3例、晚发型10例),肺出血4例(7.8%,早发型1例、晚发型3例),皮肤黏膜出血3例(5.9%,均为晚发型)。45例 (88.2%)患儿预后良好,经治疗后血小板均恢复正常;10例重症患儿除病因治疗外均使用人免疫球蛋白静脉滴注、 3例血 小板<30×109/L者同时输注血小板, 8例恢复, 2例放弃治疗; 5例患儿因基础疾病放弃治疗(包括2例重症患者),1例因 感染性休克死亡。结论 极低出生体质量儿晚发型血小板减少以感染引起为主,早发型则由胎盘功能受限引起,大部分症 状轻,重症者经治疗后也可好转。

关键词: 血小板减少症; 临床分析; 极低出生体质量儿

Abstract:  Objective To investigate the causes and clinical characteristics of thrombocytopenia in very low birth weight infants. Methods The clinical data of 51 very low birth weight infants with thrombocytopenia from January 2013 to December 2016 were retrospectively analyzed. Results Among 51 cases, there were 31 males and 20 females, gestational age was 25+4 weeks to 36+1 weeks, the median birth weight was (1285±207.9) g, and the average onset age of thrombocytopenia was (11.84±13.16) days, delayed onsets were the most seen in 39 cases (76.5%). Infection accounted for 26 (66.7%) of 39 lateonset infants, and the causes of early-onset infants included asphyxia in 5 cases, pregnancy-induced hypertension in 4 cases, intrauterine growth retardation in 4 (1 had both pregnancy-induced hypertension and intrauterine growth retardation in the mother, and 1 had asphyxia, pregnancy-induced hypertension and intrauterine growth retardation in the mother). Among 51 cases, there were 31 (60.9%) had abnormal laboratory findings without bleeding (8 of early onset and 23 of late onset); 13 (25.4%) with intracranial hemorrhage (3 of early onset and 10 of late onset); 4 (7.8%) with pulmonary hemorrhage (1 of early onset and 3 of late onset); and 3 (5.9%) with cutaneous and mucosal hemorrhage (all of late onset). Forty-five (45, 88.2%) children had good prognosis and their platelets returned to normal after treatment; 10 infants with severe thrombocytopenia were given both intravenous administration of human immunoglobulin and etiological treatments, 3 patients with platelets < 30×109/L received platelets at the same time; 8 patients recovered and 2 patients gave up treatment; 5 children gave up treatment due to basic diseases (including 2 patients with severe thrombocytopenia). One case died of septic shock. Conclusion Infection is the main cause of late-onset thrombocytopenia in very low birth weight infants, while placental dysfunction is the main cause of earlyonset of thrombocytopenia. Most of the symptoms are mild, and severe patients can also get well after treatment.

Key words: thrombocytopenia; clinical analysisvery; low birth weight infants