Chronic villitis in untreated neonatal alloimmune thrombocytopenia: An etiology for severe early intrauterine growth restriction and the effect of intravenous immunoglobulin therapy
Chronic villitis in untreated neonatal alloimmune thrombocytopenia: An etiology for severe early intrauterine growth restriction and the effect of intravenous immunoglobulin therapy
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DOI：
10.1016/j.ajog.2005.06.043
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发表时间：
2005-09-01
影响因子：
9.8
通讯作者：
Blakemore, K
中科院分区：
文献类型：
--
作者：
Althaus, J;Weir, EG;Blakemore, K
目的：本研究的目的是检查胎盘组织病理学在静脉注射免疫球蛋白治疗和未治疗的新生儿同种免疫性血小板减少症，并与临床outcomes.Study设计病理结果：胎盘从14个新生儿同种免疫性血小板减少症影响的妊娠进行了鉴定。母亲产前静脉注射免疫球蛋白的治疗和妊娠结局从医疗记录中提取。使用Fisher精确检验比较静脉注射免疫球蛋白治疗组和非静脉注射免疫球蛋白治疗组之间的胎盘组织病理学和临床结局。1例仅在诊断为颅内出血（ICH）后接受治疗的受试者从分析中排除。结果：未经治疗的妊娠表现出淋巴浆细胞性慢性绒毛炎，而静脉注射免疫球蛋白治疗的妊娠则没有（P = 0.005）。在未治疗组中，宫内生长受限和宫内胎儿死亡的发生频率与ICH相同。没有ICH，宫内生长受限，或宫内胎儿死亡发生在治疗组，虽然P值不显着。结论：慢性绒毛炎是经常表现在新生儿同种免疫性血小板减少症，静脉注射免疫球蛋白减轻这种炎症免疫反应。我们怀疑母体抗体在新生儿同种免疫性血小板减少症后遗症中的作用更为普遍，如胎儿内皮细胞损伤。(C)2005 Mosby，Inc. All rights reserved.
Objective: The objective of the study was to examine placental histopathology in intravenous immunoglobulin-treated and untreated neonatal alloimmune thrombocytopenia, and correlate pathological findings with clinical outcomes.Study design: Placentas from 14 neonatal alloimmune thrombocytopenia-affected pregnancies were identified. Maternal antepartum treatment with intravenous immunoglobulin and pregnancy outcomes were abstracted from medical records. Placental histopathology and clinical outcomes were compared between intravenous immunoglobulin and no intravenous immunoglobulin treatment groups using Fisher's exact test. One subject, treated only after an intracranial hemorrhage (ICH) was diagnosed, was excluded from the analysis. P < .05 was considered significant.Results: Untreated pregnancies demonstrated a lymphoplasmacytic chronic villitis not seen in the intravenous immunoglobulin-treated pregnancies (P = .005). Intrauterine growth restriction and intrauterine fetal demise occurred as frequently as ICH in the untreated group. No ICH, intrauterine growth restriction, or intrauterine fetal demises occurred in the treated group, although the P value was not significant.Conclusion: Chronic villitis is frequently manifest in neonatal alloimmune thrombocytopenia, with intravenous immunoglobulin alleviating this inflammatory immunologic response. We suspect a more universal role for the maternal antibody, such as fetal endothelial cell damage, in the sequelae of neonatal alloimmune thrombocytopenia. (C) 2005 Mosby, Inc. All rights reserved.