Tombak Anıl, Boztepe Burcu, Tiftik Naci, Cömert Melda, Salim Ozan, Aydın Kaniye, Gürkan Emel, Yücel Orhan Kemal, Saydam Güray, Sungur Mehmet Ali
Department of Hematology, Mersin University Faculty of Medicine, Mersin, Turkey.
Department of Internal Medicine, Mersin University Faculty of Medicine, Mersin, Turkey.
Balkan Med J. 2015 Oct;32(4):347-51. doi: 10.5152/balkanmedj.2015.151223. Epub 2015 Oct 1.
Immune thrombocytopenia (ITP) is an autoimmune disorder. It is characterized by thrombocytopenia due to thrombocyte destruction mediated by autoantibodies; however, cytotoxic and defective regulatory T-lymphocytes play an important role in its pathogenesis. While childhood ITP is usually acute, self-limiting and generally seasonal in nature, ITP in adults is usually chronic; its relation with seasons has not been studied.
We investigated whether months and/or seasons have triggering roles in adults with ITP.
Descriptive study.
A retrospective case review of adult patients with primary ITP diagnosed at various University Hospitals in cities where Mediterranean climate is seen was performed. Demographic data, date of referral and treatments were recorded. Corticosteroid-resistant, chronic and refractory cases were determined. Relation between sex, corticosteroid-resistant, chronic and refractory ITP with the seasons was also investigated.
The study included 165 patients (124 female, mean age=42.8±16.6). Most cases of primary ITP were diagnosed in the spring (p=0.015). Rates of patients diagnosed according to the seasons were as follows: 35.8% in spring, 23% in summer, 20.6% in fall, and 20.6% in winter. With respect to months, the majority of cases occurred in May (18.2%). Time of diagnosis according to the seasons did not differ between genders (p=0.699). First-line treatment was corticosteroids in 97.3%, but 35% of the cases were corticosteroid-resistant. Steroid-resistant patients were mostly diagnosed in the spring (52.1%) (p=0.001). ITP was chronic in 52.7% of the patients and they were also diagnosed mostly in the spring (62.7%) (p=0.149).
This is the first study showing seasonal association of ITP in adults and we have observed that ITP in adults is mostly diagnosed in the spring. The reason why more patients are diagnosed in the spring may be due to the existence of atmospheric pollens reaching maximum levels in the spring in places where a Mediterranean climate is seen.
免疫性血小板减少症（ITP）是一种自身免疫性疾病。其特征是由于自身抗体介导的血小板破坏导致血小板减少；然而，细胞毒性和有缺陷的调节性T淋巴细胞在其发病机制中起重要作用。儿童ITP通常是急性、自限性的，且一般具有季节性，而成人ITP通常是慢性的；其与季节的关系尚未得到研究。
我们调查了月份和/或季节对成人ITP是否有触发作用。
描述性研究。
对在地中海气候城市的各大学医院诊断为原发性ITP的成年患者进行回顾性病例审查。记录人口统计学数据、转诊日期和治疗情况。确定对皮质类固醇耐药、慢性和难治性病例。还调查了性别、对皮质类固醇耐药、慢性和难治性ITP与季节之间的关系。
该研究纳入了165例患者（124例女性，平均年龄=42.8±16.6）。大多数原发性ITP病例在春季被诊断出来（p=0.015）。按季节诊断的患者比例如下：春季为35.8%，夏季为23%，秋季为20.6%，冬季为20.6%。按月来看，大多数病例发生在5月（18.2%）。按季节诊断的时间在性别之间没有差异（p=0.699）。一线治疗97.3%采用皮质类固醇，但35%的病例对皮质类固醇耐药。对类固醇耐药的患者大多在春季被诊断出来（52.1%）（p=0.001）。52.7%的患者ITP为慢性，他们也大多在春季被诊断出来（62.7%）（p=0.149）。
这是第一项显示成人ITP存在季节性关联的研究，我们观察到成人ITP大多在春季被诊断出来。春季诊断出更多患者的原因可能是在地中海气候地区春季大气花粉浓度达到最高水平。
