专家共识
ENGLISH ABSTRACT
原发免疫性血小板减少症妊娠期诊治专家共识
中华医学会妇产科学分会产科学组
作者及单位信息
·
DOI: 10.3760/cma.j.cn112141-20221101-00671
Expert consensus on diagnosis and treatment of primary immune thrombocytopenia in pregnancy
Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
Authors Info & Affiliations
Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association
·
DOI: 10.3760/cma.j.cn112141-20221101-00671
6223
1891
0
1
165
39
PDF下载
APP内阅读
摘要

原发免疫性血小板减少症(ITP)是一种获得性自身免疫性出血性疾病。妊娠合并ITP患者病情可随妊娠的进展而加重,导致妊娠期及分娩期出血风险增加,部分妊娠合并ITP患者分娩的新生儿可发生新生儿血小板减少症。规范管理妊娠合并ITP可以有效降低ITP患者的出血风险,改善母儿结局。但因妊娠合并ITP发生率较低,缺乏高质量的循证医学证据,临床存在诊疗不规范及过度诊疗现象。为进一步规范ITP的妊娠期管理,中华医学会妇产科学分会产科学组组织多学科专家,在参照国内外相关指南的基础上,共同讨论制定本共识,旨在为我国妊娠合并ITP的诊治提供指导性意见。

引用本文

中华医学会妇产科学分会产科学组. 原发免疫性血小板减少症妊娠期诊治专家共识[J]. 中华妇产科杂志,2023,58(03):170-177.

DOI:10.3760/cma.j.cn112141-20221101-00671

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价
原发免疫性血小板减少症(primary immune thrombocytopenia,ITP),既往称特发性血小板减少性紫癜,是一种获得性自身免疫性出血性疾病。ITP以无明确诱因的孤立性外周血血小板计数减少为主要特点,临床表现为无症状性血小板减少、皮肤黏膜出血以及重要器官出血。ITP的主要发病机制是血小板自身抗原免疫耐受性丢失,导致体液和细胞免疫异常活化,共同介导血小板破坏加速及巨核细胞产生血小板不足1。妊娠合并ITP的发生率约为8/100 000,部分患者为妊娠期首次诊断2。ITP患者在妊娠期病情易加重,严重者可导致母体器官自发出血,部分ITP孕妇分娩的新生儿可发生新生儿血小板减少症3 , 4 , 5 , 6。1996年,英国血液学会(British Society for Haematology,BSH)首次针对妊娠合并ITP制订了诊治指南7。BSH、美国血液学会(American Society of Hematology,ASH)、美国妇产科医师协会(American College of Obstetricians and Gynecologists,ACOG)及国际ITP工作组制订的ITP诊治指南中均涉及妊娠合并ITP的诊疗建议并不断更新8 , 9 , 10 , 11。2019年,ACOG、ASH、国际ITP工作组也均针对妊娠合并ITP提出或更新了诊疗推荐建议212 , 13。但由于缺乏充足的随机对照试验临床研究,各指南的诊治建议主要基于临床经验及专家共识。在参照上述指南及中华医学会血液学分会血栓与止血学组制定的“成人原发免疫性血小板减少症诊断与治疗中国指南(2020年版)”14的基础上,中华医学会妇产科学分会产科学组组织相关学科专家,共同讨论制定本共识,旨在为我国妊娠合并ITP的诊治提供指导性意见。
试读结束,您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Zufferey A , Kapur R , Semple JW . Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP)[J]. J Clin Med, 2017, 6(2):16. DOI: 10.3390/jcm6020016 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Provan D , Arnold DM , Bussel JB , et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia[J]. Blood Adv, 2019, 3(22):3780-3817. DOI: 10.1182/bloodadvances.2019000812 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Loustau V , Debouverie O , Canoui-Poitrine F , et al. Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women[J]. Br J Haematol, 2014, 166(6):929-935. DOI: 10.1111/bjh.12976 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Care A , Pavord S , Knight M , et al. Severe primary autoimmune thrombocytopenia in pregnancy: a national cohort study[J]. BJOG, 2018, 125(5):604-612. DOI: 10.1111/1471-0528.14697 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Xu X , Liang MY , Dou S , et al. Evaluation of glucocorticoid compared with immunoglobulin therapy of severe immune thrombocytopenia during pregnancy: response rate and complication[J]. Am J Reprod Immunol, 2018, 80(4):e13000. DOI: 10.1111/aji.13000 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Sun D , Shehata N , Ye XY , et al. Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy[J]. Blood, 2016, 128(10):1329-1335. DOI: 10.1182/blood-2016-04-710285 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Letsky EA , Greaves M . Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology[J]. Br J Haematol, 1996, 95(1):21-26.
返回引文位置Google Scholar
百度学术
万方数据
[8]
Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy[J]. Br J Haematol, 2003, 120(4):574-596. DOI: 10.1046/j.1365-2141.2003.04131.x .
[9]
Neunert C , Lim W , Crowther M , et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia[J]. Blood, 2011, 117(16):4190-4207. DOI: 10.1182/blood-2010-08-302984 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Provan D , Stasi R , Newland AC , et al. International consensus report on the investigation and management of primary immune thrombocytopenia[J]. Blood, 2010, 115(2):168-186. DOI: 10.1182/blood-2009-06-225565 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Practice Bulletin No. 166: thrombocytopenia in pregnancy[J]. Obstet Gynecol, 2016, 128(3):e43-53. DOI: 10.1097/AOG.0000000000001641 .
[12]
Neunert C , Terrell DR , Arnold DM , et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia[J]. Blood Adv, 2019, 3(23):3829-3866. DOI: 10.1182/bloodadvances.2019000966 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
ACOG Practice Bulletin No. 207 Summary: Thrombocytopenia in pregnancy[J]. Obstet Gynecol, 2019, 133(3):589-591. DOI: 10.1097/AOG.0000000000003101 .
[14]
中华医学会血液学分会血栓与止血学组. 成人原发免疫性血小板减少症诊断与治疗中国指南(2020年版)[J]. 中华血液学杂志, 2020, 41(8):617-623. DOI: 10.3760/cma.j.issn.0253-2727.2020.08.001 .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Miyakawa Y , Kashiwagi H , Takafuta T , et al. Consensus report for the management of pregnancy with primary immune thrombocytopenia[J]. Rinsho Ketsueki, 2014, 55(8):934-947.
返回引文位置Google Scholar
百度学术
万方数据
[16]
徐雪, 梁梅英, 郭天元. 2014年日本“妊娠合并特发性血小板减少性紫癜诊疗共识”解读[J]. 中华围产医学杂志, 2015, 18(4):246-251. DOI: 10.3760/cma.j.issn.1007-9408.2015.04.001 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Reese JA , Peck JD , Yu Z , et al. Platelet sequestration and consumption in the placental intervillous space contribute to lower platelet counts during pregnancy[J]. Am J Hematol, 2019, 94(1):E8-E11. DOI: 10.1002/ajh.25321 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Reese JA , Peck JD , Deschamps DR , et al. Platelet counts during pregnancy[J]. N Engl J Med, 2018, 379(1):32-43. DOI: 10.1056/NEJMoa1802897 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Gernsheimer T , James AH , Stasi R . How I treat thrombocytopenia in pregnancy[J]. Blood, 2013, 121(1):38-47. DOI: 10.1182/blood-2012-08-448944 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Rodeghiero F , Stasi R , Gernsheimer T , et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group[J]. Blood, 2009, 113(11):2386-2393. DOI: 10.1182/blood-2008-07-162503 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Kong Z , Qin P , Xiao S , et al. A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy[J]. Blood, 2017, 130(9):1097-1103. DOI: 10.1182/blood-2017-01-761262 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Bauer ME , Arendt K , Beilin Y , et al. The Society for Obstetric Anesthesia and Perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia[J]. Anesth Analg, 2021, 132(6):1531-1544. DOI: 10.1213/ANE.0000000000005355 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Roberts I , Stanworth S , Murray NA . Thrombocytopenia in the neonate[J]. Blood Rev, 2008, 22(4):173-186. DOI: 10.1016/j.blre.2008.03.004 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Elgendy MM , Durgham R , Othman HF , et al. Platelet transfusion and outcomes of preterm infants: a cross-sectional study[J]. Neonatology, 2021, 118(4):425-433. DOI: 10.1159/000515900 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Bayhan T , Tavil B , Korkmaz A , et al. Neonates born to mothers with immune thrombocytopenic purpura: a single-center experience of 20 years[J]. Blood Coagul Fibrinolysis, 2016, 27(1):19-23. DOI: 10.1097/MBC.0000000000000378 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Gill KK , Kelton JG . Management of idiopathic thrombocytopenic purpura in pregnancy[J]. Semin Hematol, 2000, 37(3):275-289. DOI: 10.1016/s0037-1963(00)90106-9 .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Bussel JB , Zabusky MR , Berkowitz RL , et al. Fetal alloimmune thrombocytopenia[J]. N Engl J Med, 1997, 337(1):22-26. DOI: 10.1056/NEJM199707033370104 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
American College of Obstetricians and Gynecologists. ACOG practice bulletin: thrombocytopenia in pregnancy. Clinical management guidelines for obstetrician-gynecologists[J]. Int J Gynaecol Obstet, 1999, 67(2):117-128.
返回引文位置Google Scholar
百度学术
万方数据
[29]
Subbaiah M , Kumar S , Roy KK , et al. Pregnancy outcome in patients with idiopathic thrombocytopenic purpura[J]. Arch Gynecol Obstet, 2014, 289(2):269-273. DOI: 10.1007/s00404-013-2958-x .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Donato H . Neonatal thrombocytopenia: a review. I. Definitions, differential diagnosis, causes, immune thrombocytopenia[J]. Arch Argent Pediatr, 2021, 119(3):e202-e214. DOI: 10.5546/aap.2021.eng.e202 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
van der Lugt NM , van Kampen A , Walther FJ , et al. Outcome and management in neonatal thrombocytopenia due to maternal idiopathic thrombocytopenic purpura[J]. Vox Sang, 2013, 105(3):236-243. DOI: 10.1111/vox.12036 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
Kawaguchi K , Matsubara K , Takafuta T , et al. Factors predictive of neonatal thrombocytopenia in pregnant women with immune thrombocytopenia[J]. Int J Hematol, 2014, 99(5):570-576. DOI: 10.1007/s12185-014-1562-6 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
Kimberlin DW , Brady MT , Jackson MA , et al. Red book: 2018 report of the Committee on Infectious Diseases[M]. 31st ed. Itasca: American Academy of Pediatrics, 2018: 39.
[34]
郑跃杰, 张丹霞, 李永柏, . 儿童预防接种禁忌证基层筛查及转诊建议(深圳)[J]. 中华实用儿科临床杂志, 2021, 36(16):1201-1204. DOI: 10.3760/cma.j.cn101070-20210723-00867 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Sammaritano LR , Bermas BL , Chakravarty EE , et al. 2020 American College of Rheumatology Guideline for the management of reproductive health in rheumatic and musculoskeletal diseases[J]. Arthritis Rheumatol, 2020, 72(4):529-556. DOI: 10.1002/art.41191 .
返回引文位置Google Scholar
百度学术
万方数据
[36]
Hauschner H , Rosenberg N , Seligsohn U , et al. Persistent neonatal thrombocytopenia can be caused by IgA antiplatelet antibodies in breast milk of immune thrombocytopenic mothers[J]. Blood, 2015, 126(5):661-664. DOI: 10.1182/blood-2014-12-614446 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
梁梅英,北京大学人民医院妇产科,北京 100044,Email:mocdef.3ab619211gniyml
B
杨慧霞,北京大学第一医院妇产科,北京 100034,Email:nc.defudabe.umjbaixiuhgnay
C
中华医学会妇产科学分会产科学组. 原发免疫性血小板减少症妊娠期诊治专家共识[J]. 中华妇产科杂志, 2023, 58(3): 170-177. DOI: 10.3760/cma.j.cn112141-20221101-00671.
D
所有作者声明无利益冲突
评论 (0条)
注册
登录
时间排序
暂无评论,发表第一条评论抢沙发
MedAI助手(体验版)
文档即答
智问智答
机器翻译
回答内容由人工智能生成,我社无法保证其准确性和完整性,该生成内容不代表我们的态度或观点,仅供参考。
生成快照
文献快照

你好,我可以帮助您更好的了解本文,请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持:

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号