Passamonti Francesco, Randi Maria Luigia, Rumi Elisa, Pungolino Ester, Elena Chiara, Pietra Daniela, Scapin Margherita, Arcaini Luca, Tezza Fabiana, Moratti Remigio, Pascutto Cristiana, Fabris Fabrizio, Morra Enrica, Cazzola Mario, Lazzarino Mario
Department of Hematology, University of Pavia Medical School, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.
Blood. 2007 Jul 15;110(2):485-9. doi: 10.1182/blood-2007-01-071068. Epub 2007 Apr 10.
Essential thrombocythemia (ET) may occur in women of childbearing age. To investigate the risk of pregnancy complications, we studied 103 pregnancies that occurred in 62 women with ET. The 2-tailed Fisher exact test showed that pregnancy outcome was independent from that of a previous pregnancy. The rate of live birth was 64%, and 51% of pregnancies were uneventful. Maternal complications occurred in 9%, while fetal complications occurred in 40% of pregnancies. The Mantel-Haenszel method showed that fetal loss in women with ET was 3.4-fold higher (95% confidence interval [CI]: 3-3.9; P < .001) than in the general population. Half of the women studied carried the JAK2 (617V>F) mutation, and a multivariate logistic regression model identified this mutation as an independent predictor of pregnancy complications (P = .01). Neither the platelet count nor the leukocyte count was a risk factor. JAK2 (617V>F)-positive patients had an odds ratio of 2.02 (95% CI: 1.1 - 3.8) of developing complications in comparison with JAK2 (617V>F)-negative patients. Aspirin did not prevent complication in JAK2 (617V>F)-positive patients and appeared to worsen outcome in JAK2 (617V>F)-negative patients. A relationship was found between JAK2 (617V>F) and fetal loss (P = .05). This study indicates that patients carrying the JAK2 (617V>F) mutation have higher risk of developing pregnancy complications.
原发性血小板增多症（ET）可发生于育龄女性。为了调查妊娠并发症的风险，我们研究了62例患ET的女性所发生的103次妊娠。双侧Fisher精确检验显示，妊娠结局与既往妊娠无关。活产率为64%，51%的妊娠过程顺利。9%的孕妇出现母体并发症，而40%的妊娠出现胎儿并发症。Mantel-Haenszel法显示，ET女性的胎儿丢失率比一般人群高3.4倍（95%置信区间[CI]：3 - 3.9；P <.001）。半数研究对象携带JAK2（617V>F）突变，多因素逻辑回归模型将该突变确定为妊娠并发症的独立预测因素（P = 0.01）。血小板计数和白细胞计数均不是危险因素。与JAK2（617V>F）阴性患者相比，JAK2（617V>F）阳性患者发生并发症的比值比为2.02（95%CI：1.1 - 3.8）。阿司匹林不能预防JAK2（617V>F）阳性患者的并发症，且似乎会使JAK2（617V>F）阴性患者的结局恶化。发现JAK2（617V>F）与胎儿丢失之间存在关联（P = 0.05）。本研究表明，携带JAK2（617V>F）突变的患者发生妊娠并发症的风险更高。
