儿童免疫性血小板减少性紫癜中静脉注射免疫球蛋白治疗反应的预测因素

Predictive factors of response to IVIG in pediatric immune thrombocytopenic purpura.

作者信息

Higashide Yukiko, Hori Tsukasa, Yoto Yuko, Kabutoya Hiroyuki, Honjo Saho, Sakai Yoshiyuki, Nojima Masanori, Yoda Minami, Yamamoto Masaki, Tsutsumi Hiroyuki

机构信息

Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan.

Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan.

出版信息

Pediatr Int. 2018 Apr;60(4):357-361. doi: 10.1111/ped.13505. Epub 2018 Mar 2.

DOI:10.1111/ped.13505

PMID:29297955

Abstract

BACKGROUND

Immune thrombocytopenic purpura (ITP) is commonly treated with i.v. immunoglobulin (IVIG).

METHODS

We retrospectively evaluated whether pretreatment clinical and laboratory finding could predict the short- and long-term response to IVIG.

RESULTS

Short-term response was estimated by platelet count 2 weeks after IVIG, and long-term response was assessed on thrombocytopenia-free survival (TFS). TFS was defined as the probability of survival without treatment failure after initial IVIG, such as relapse, requirement for additional therapeutic interventions, or progressing to chronic ITP. Seventy-six patients with newly diagnosed ITP who were initially treated with IVIG were evaluated. Fifty-three patients (69.7%) were determined as responders at 2 weeks after IVIG. On multivariate analysis, age ≥23 months (P = 0.020) and platelet count <9.0 × 10 /L (P = 0.018) were considered to be unfavorable factors for short-term response. Cumulative proportion of long-term (1 year) good prognosis was estimated at 53.0% (95%CI: 40.8-65.2). On multivariate analysis of unfavorable factors for long-term response, age ≥23 months (P = 0.020) was the only significant factor.

CONCLUSIONS

For new-onset ITP in patients aged >2 years, corticosteroid therapy in addition to IVIG may be considered as the initial treatment.

摘要

背景

免疫性血小板减少性紫癜（ITP）通常采用静脉注射免疫球蛋白（IVIG）进行治疗。

方法

我们回顾性评估了治疗前的临床和实验室检查结果是否能够预测对IVIG的短期和长期反应。

结果

通过IVIG治疗2周后的血小板计数评估短期反应，通过无血小板减少生存期（TFS）评估长期反应。TFS定义为初次IVIG治疗后无治疗失败（如复发、需要额外治疗干预或进展为慢性ITP）的生存概率。对76例初诊ITP且最初接受IVIG治疗的患者进行了评估。53例患者（69.7%）在IVIG治疗2周后被判定为反应者。多因素分析显示，年龄≥23个月（P = 0.020）和血小板计数<9.0×10⁹/L（P = 0.018）被认为是短期反应的不利因素。长期（1年）良好预后的累积比例估计为53.0%（95%CI：40.8 - 65.2）。对长期反应不利因素的多因素分析显示，年龄≥23个月（P = 0.020）是唯一的显著因素。