妊娠合并原发免疫性血小板减少症患者采用重组人血小板生成素治疗的回顾性对比队列研究。
Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study.
机构信息
Department of Ob and Gyn, Fujian Medical University Union Hospital, Fuzhou, China.
Fujian Institute of Haematology, Fujian Provincial Key Laboratory of Haematology, Fujian Medical University Union Hospital, Fuzhou, China.
出版信息
BMC Pregnancy Childbirth. 2023 Nov 27;23(1):820. doi: 10.1186/s12884-023-06134-y.
BACKGROUND
Treatment options for pregnant women with immune thrombocytopenia (ITP) who do not respond to first-line treatment are limited. Few studies have reported the use of recombinant human thrombopoietin (rhTPO) for this subset of patients.
AIMS
To investigate the efficacy and safety of rhTPO in ITP during pregnancy and determine obstetric outcomes and predictors of treatment response.
METHODS
From July 2013 to October 2022, the data of 81 pregnant women with ITP and a platelet count < 30 × 10/L who did not respond to steroids and/or intravenous immunoglobulin were retrospectively analysed. Of these patients, 33 received rhTPO treatment (rhTPO group) while 48 did not (control group). Baseline characteristics, haematological disease outcomes before delivery, obstetric outcomes, and adverse events were compared between groups. In the rhTPO group, a generalised estimating equation (GEE) was used to investigate the factors influencing the response to rhTPO treatment.
RESULTS
The baseline characteristics were comparable between both groups (P > 0.05, both). Compared with controls, rhTPO patients had higher platelet counts (median [interquartile range]: 42 [21.5-67.5] vs. 25 [19-29] × 10/L, P = 0.002), lower bleeding rate (6.1% vs. 25%, P = 0.027), and lower platelet transfusion rate before delivery (57.6% vs. 97.9%, P < 0.001). Gestational weeks of delivery (37.6 [37-38.4] vs 37.1 [37-37.2] weeks, P = 0.001) were longer in the rhTPO group than in the control group. The rates of caesarean section, postpartum haemorrhage, foetal or neonatal complications, and complication types in both groups were similar (all P > 0.05). No liver or renal function impairment or thrombosis cases were observed in the rhTPO group. GEE analysis revealed that the baseline mean platelet volume (MPV) (odds ratio [OR]: 0.522, P = 0.002) and platelet-to-lymphocyte ratio (PLR) (OR: 1.214, P = 0.025) were predictors of response to rhTPO treatment.
CONCLUSION
rhTPO may be an effective and safe treatment option for pregnancies with ITP that do not respond to first-line treatment; it may have slightly prolonged the gestational age of delivery. Patients with a low baseline MPV and high baseline PLR may be more responsive to rhTPO treatment. The present study serves as a foundation for future research.
背景
对于一线治疗无效的妊娠免疫性血小板减少症（ITP）患者，治疗选择有限。很少有研究报告使用重组人血小板生成素（rhTPO）治疗这部分患者。
目的
探讨 rhTPO 在妊娠 ITP 中的疗效和安全性，并确定产科结局和治疗反应的预测因素。
方法
回顾性分析 2013 年 7 月至 2022 年 10 月间 81 例血小板计数<30×10/L且对类固醇和/或静脉免疫球蛋白无反应的妊娠 ITP 患者的数据。其中 33 例接受 rhTPO 治疗（rhTPO 组），48 例未接受治疗（对照组）。比较两组间的基线特征、分娩前血液学疾病结局、产科结局和不良事件。在 rhTPO 组中，采用广义估计方程（GEE）探讨影响 rhTPO 治疗反应的因素。
结果
两组间的基线特征相似（P>0.05，均）。与对照组相比，rhTPO 患者的血小板计数更高（中位数[四分位数间距]：42[21.5-67.5] vs. 25[19-29]×10/L，P=0.002），出血率更低（6.1% vs. 25%，P=0.027），分娩前血小板输注率更低（57.6% vs. 97.9%，P<0.001）。rhTPO 组的分娩孕周（37.6[37-38.4] vs. 37.1[37-37.2]周，P=0.001）长于对照组。两组剖宫产率、产后出血、胎儿或新生儿并发症及并发症类型相似（均 P>0.05）。rhTPO 组未发生肝肾功能损害或血栓形成。GEE 分析显示，基线平均血小板体积（MPV）（比值比[OR]：0.522，P=0.002）和血小板与淋巴细胞比值（PLR）（OR：1.214，P=0.025）是 rhTPO 治疗反应的预测因素。
结论
rhTPO 可能是一线治疗无效的妊娠 ITP 的一种有效且安全的治疗选择，它可能略微延长分娩的孕周。基线 MPV 较低和基线 PLR 较高的患者可能对 rhTPO 治疗更敏感。本研究为今后的研究奠定了基础。
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