Ekstrand Charlotta, Linder Marie, Cherif Honar, Kieler Helle, Bahmanyar Shahram
Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm.
Department of Medical Science Haematology, Uppsala University, Uppsala.
Blood Coagul Fibrinolysis. 2019 Oct;30(7):350-356. doi: 10.1097/MBC.0000000000000846.
: Asymptomatic patients with primary chronic immune thrombocytopenia (ITP) are not recommended treatment if their platelet counts are above 30 × 10/l. Factors such as age and comorbidities may influence clinical manifestations and should be considered for treatment decisions. The aim of this study was to determine the impact of clinical characteristics for initiation of ITP treatment, and the patterns of ITP treatment given. We performed an observational cohort study in Sweden with information from medical records and National Health Registers. Adults diagnosed with incident primary ITP between years 2009 and 2016 were included. Multinomial logistic regression was used to assess the impact of factors predicting treatment start. Out of 858 patients with chronic ITP from 71 hospitals we identified 585 (68%) with a first ITP treatment. For 537 (92%) corticosteroids were the first choice. The median platelet counts at start of treatment was 12 × 10/l (interquartile range 5-27 × 10/l). The variables predicting treatment start were platelet counts below 20 × 10/l and treatment with antihypertensive drugs. Patients with diabetes were less likely to receive corticosteroids. Severe bleeding occurred in 75 (13%) of the patients. Platelet counts below 20 × 10/l, antihypertensive treatment and bleedings were the strongest predictors of treatment start, diabetes yielded lower odds to start corticosteroid treatment. The majority of the patients had corticosteroids as first treatment while second treatment was diverse. Asymptomatic thrombocytopenia is not considered a reason as such for initiating treatment. In the latter years, splenectomy seemed to occur later in the course of treatment.
对于原发性慢性免疫性血小板减少症（ITP）且血小板计数高于30×10⁹/L的无症状患者，不建议进行治疗。年龄和合并症等因素可能影响临床表现，在做出治疗决策时应予以考虑。本研究的目的是确定ITP治疗起始的临床特征的影响以及所给予的ITP治疗模式。我们在瑞典进行了一项观察性队列研究，利用病历和国家健康登记册中的信息。纳入了2009年至2016年间诊断为初发原发性ITP的成年人。采用多项逻辑回归来评估预测治疗开始的因素的影响。在来自71家医院的858例慢性ITP患者中，我们确定了585例（68%）接受了首次ITP治疗。对于537例（92%）患者，皮质类固醇是首选。治疗开始时的血小板计数中位数为12×10⁹/L（四分位间距5 - 27×10⁹/L）。预测治疗开始的变量是血小板计数低于20×10⁹/L和使用抗高血压药物。糖尿病患者接受皮质类固醇治疗的可能性较小。75例（13%）患者发生了严重出血。血小板计数低于20×10⁹/L、抗高血压治疗和出血是治疗开始的最强预测因素，糖尿病患者开始皮质类固醇治疗的几率较低。大多数患者以皮质类固醇作为首次治疗，而第二次治疗则多种多样。无症状性血小板减少症本身不被视为开始治疗的理由。在后期，脾切除术似乎在治疗过程中出现得较晚。
