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儿童和成人免疫性血小板减少症的前瞻性对比观察研究:2 年随访。

A comparative prospective observational study of children and adults with immune thrombocytopenia: 2-year follow-up.

机构信息

Department of Hematology/Oncology, University Children's Hospital Basel, Basel, Switzerland.

Department of Hematology, University Hospital Basel, Basel, Switzerland.

出版信息

Am J Hematol. 2018 Jun;93(6):751-759. doi: 10.1002/ajh.25086. Epub 2018 Mar 30.

Abstract

Comparative clinical studies of children and adults with immune thrombocytopenia (ITP) are poorly covered in the literature. However, the accepted classification of ITP-childhood ITP and adult ITP-results in considerable differences in treatment protocols and practice guidelines. The analysis of the Pediatric and Adult Registry on Chronic ITP (PARC-ITP) of patients at first presentation demonstrated fewer differences in clinical and laboratory findings at initial diagnosis between children and adults than expected. The present report of 2-year follow-up data supports the hypothesis that there are common aspects of childhood and adult ITP. Data of 3360 children and 420 adults were collected during the time of 2004 until 2015 at initial diagnosis. Follow-up information was available for 51% and 33% of children and 66% and 49% of adults at 12- and 24-months, respectively. Similarities were found in unexpected areas of ITP, such as the rate of late remission at 12 and 24 months, reported bleeding sites, platelet count in bleeders, and the frequency of treated patients with persistent or chronic ITP. Differences were confirmed for the overall rate of remission and treatment modalities. Unexpected differences were found in the percentage of nonbleeders, with more adults in the nonbleeder group. More studies are needed to investigate different age groups with the aim to optimize their management.

摘要

儿童和成人免疫性血小板减少症 (ITP) 的临床对比研究在文献中报道较少。然而,公认的 ITP 分类——儿童 ITP 和成人 ITP——导致治疗方案和实践指南存在显著差异。对慢性 ITP 儿科和成人登记 (PARC-ITP) 患者首次就诊的分析表明,与预期相比,儿童和成人在初始诊断时的临床和实验室发现差异较小。本报告中对 2 年随访数据的分析支持了以下假设,即儿童和成人 ITP 存在共同的方面。2004 年至 2015 年期间,共收集了 3360 名儿童和 420 名成人的初始诊断数据。分别有 51%和 33%的儿童和 66%和 49%的成人在 12 个月和 24 个月时可获得随访信息。在 ITP 的意外领域中发现了相似之处,例如 12 个月和 24 个月时的晚期缓解率、报告的出血部位、出血患者的血小板计数以及持续性或慢性 ITP 的治疗患者的频率。在总体缓解率和治疗方式方面存在差异。在非出血者的百分比方面也发现了意外的差异,非出血者中成年人的比例更高。需要进行更多的研究来调查不同年龄组,以优化他们的管理。

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