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Pregnancy outcomes following recovery from acquired thrombotic thrombocytopenic purpura
发布于：2014年2月23日 文字：【大】【中】【小】
Blood. 2014 Jan 7. [Epub ahead of print]
Pregnancy outcomes following recovery from acquired thrombotic thrombocytopenic purpura.
Jiang Y, McIntosh JJ, Reese JA, Deford CC, Kremer Hovinga JA, L?mmle B, Terrell DR, Vesely SK, Knudtson EJ, George JN.
Pregnancy may precipitate acute episodes of thrombotic thrombocytopenic purpura (TTP), but pregnancy outcomes in women who have recovered from acquired TTP are not well documented. We analyzed pregnancy outcomes following recovery from TTP associated with acquired, severe ADAMTS13 deficiency (ADAMTS13 activity <10%) in women enrolled in the Oklahoma TTP-HUS (hemolytic-uremic syndrome) Registry, 1995-2012. We also systematically searched for published reports on outcomes of pregnancies following recovery from TTP associated with acquired, severe ADAMTS13 deficiency. Ten women in the Oklahoma Registry had 16 subsequent pregnancies, 1999-2013. Two women had recurrent TTP, which occurred nine and 29 days postpartum. Five of 16 pregnancies (31%, 95% confidence interval, 11-59%) in three women were complicated by preeclampsia, a frequency greater than USpopulation estimates (2.1 - 3.2%). Thirteen (81%) pregnancies resulted in normal children. The literature search identified 382 articles. Only six articles reported pregnancies in women who had recovered from TTP associated with acquired, severe ADAMTS13 deficiency, describing 10 pregnancies in eight women. TTP recurred in six pregnancies. Conclusions: With prospective complete follow-up, recurrent TTP complicating subsequent pregnancies inOklahomapatients is uncommon, but the occurrence of preeclampsia may be increased. Most pregnancies following recovery from TTP inOklahomapatients result in normal children.
在正常妊娠的中晚期，血ADAMTS-13活性会出现生理性下降，所以部分血栓性血小板减少性紫癜（TTP）患者初次发病的诱因即为妊娠，或部分患者在妊娠后TTP复发。该报道总结分析了1995-2012年Oklahoma TTP-HUS注册中心获得性TTP缓解后再妊娠的患者，共有10例患者、妊娠16次，2/10例TTP复发（分别在产后第9天和第29天），5/16次妊娠（31%）出现先兆子痫（高于普通人群的2.1-3.2%），13/16次妊娠成功正常分娩；提示获得性TTP患者在病情缓解后妊娠TTP复发不常见，但先兆子痫的发生率增高。但既往文献总结发现：6/10次妊娠出现TTP复发，相对较高，可能受到发表误差影响及样本量小。