State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, People's Republic of China.
Ann Hematol. 2013 Jan;92(1):79-87. doi: 10.1007/s00277-012-1567-2. Epub 2012 Sep 6.
Immune thrombocytopenia (ITP), often diagnosed in the elderly, is a hematologic disorder induced by autoimmune mechanism. In this retrospective study, we evaluated the clinical features, the risk of bleeding, and the response to treatment in 525 elderly ITP patients (age ≥60 years) diagnosed at our center from 1980 to 2009. There were more females at 60-74 years of age (P = 0.044). The median duration of follow-up was 27 months (range 1-253 months). Ten patients developed thrombosis during treatment of ITP. At diagnosis, 461 patients (87.8 %) had signs of bleeding. The risk of severe bleeding was associated with both platelet count (P < 0.001; odds ratio (OR), 0.973) and age (P = 0.025; OR, 1.039). The cutoff points in the platelet count at which bleeding and severe bleeding would begin to appear were 29.5 × 10(9) and 21.5 × 10(9)/L, respectively. Sixteen of 144 patients (11.1 %) who did not receive any treatment achieved remission spontaneously. The total response rate to treatment was 62.4 % (166/266). The median time to remission was 7 days, and combined use of intravenous immunoglobulin and steroids took effect faster than use of steroids alone (P = 0.001). Fifty-two patients (31.3 %) relapsed during follow-up. Of the 27 patients who died during follow-up, seven deaths were directly attributed to ITP. In conclusion, the response rate has been improved since the last 10 years. ITP is also a self-limited disease to some extent in the elderly, but easy to relapse. This review represents the largest collection of elderly ITP patients in China in a single center.
免疫性血小板减少症（ITP）常发生于老年人，是一种由自身免疫机制引起的血液系统疾病。在这项回顾性研究中，我们评估了 525 例在我院于 1980 年至 2009 年期间诊断为 ITP 的老年患者（年龄≥60 岁）的临床特征、出血风险和治疗反应。60-74 岁年龄段女性患者更多（P=0.044）。中位随访时间为 27 个月（范围 1-253 个月）。10 例患者在治疗 ITP 期间发生血栓形成。诊断时，461 例（87.8%）患者有出血体征。严重出血的风险与血小板计数（P<0.001；比值比（OR），0.973）和年龄（P=0.025；OR，1.039）相关。血小板计数出现出血和严重出血的临界值分别为 29.5×10(9)和 21.5×10(9)/L。144 例未接受任何治疗的患者中有 16 例（11.1%）自发缓解。治疗总反应率为 62.4%（166/266）。缓解中位时间为 7 天，静脉注射免疫球蛋白和皮质类固醇联合使用比单独使用皮质类固醇起效更快（P=0.001）。52 例（31.3%）患者在随访期间复发。在 27 例死亡的患者中，有 7 例直接死于 ITP。总之，自过去 10 年来，缓解率已有所提高。ITP 在一定程度上也是老年人的自限性疾病，但容易复发。本研究代表了中国单一中心最大的老年 ITP 患者集合。
