Wang Li-Yuan, Liu Kang-Kang, Chu Jin-Hua, Yang Lin-Hai, Xie Zhi-Wei, Zhang Kun-Long, Chai Hua-Ju, Wu Zheng-Yu, Wang Ning-Ling
Department of Pediatric Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China.
Department of Pediatric Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China,E-mail: zwnltt @126.com.
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2021 Jun;29(3):881-886. doi: 10.19746/j.cnki.issn.1009-2137.2021.03.036.
To explore the influencing factors in children with chronicity immune thrombocytopenia (ITP), and to provide basis for judging the prognosis and treatment in children with ITP.
The clinical data of children with ITP admitted to The Second Affiliated Hospital of Anhui Medical University in the past 5 years were retrospectively analyzed and followed up for more than 1 year. According to the inclusion criteria, the eligible cases (328 cases in total) were selected and collected through medical record system retrieval, outpatient clinic and telephone follow-up. Independent influencing factors affecting the prognosis of children with ITP were obtained through single-factor and multi-factor logistic analysis, and their predictive value for the prognosis of ITP in children were evaluated.
Of 328 children with ITP, 208 were newly diagnosed with ITP (64%), 54 were persistent ITP (16%), 66 were chronic ITP (20%), and the remission rate within 1 year was 79.9%. The results of univariate analysis showed that, age, pre-morbidity history of infection and vaccination, antinuclear antibodies, initial absolute lymphocyte count（ALC） and treatment options were related to the prognosis of the children (P<0.05). Multivariate analysis showed that the history of infection and vaccination before onset, initial treatment options, and ALC at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP (P<0.05). The time for platelet recovery to 100×10/L in the initial treatment group combined with intravenous immunoglobulin (IVIG) was shorter than that in the single corticosteroids group (P<0.01). The receivers operating characteristic (ROC) was drawn with the development of chronic disease (course >12 months) as state variable and ALC or ALC combined with preceding infection or vaccination history as test variable. The results showed that when the absolute value of lymphocytes was 3.80×10/L, the area under the curve was the largest (0.787), the sensitivity was 80.6%, and the specificity was 65.53% (P<0.01), the combined results showed that the maximum area under the curve was 0.859, the sensitivity was 77.61%, and the specificity was 78.41%.
The initial treatment plan combined with IVIG can reduce the occurrence of chronicity in children with ITP, and its efficacy is better than that of the single corticosteroids group (the platelet recovery time is shorter); history of preceding infection or vaccination, ALC at the time of initial diagnosis are independent factors affecting the prognosis of children with ITP, and the combination of the two shows a better predictive value for the prognosis.
探讨儿童慢性免疫性血小板减少症（ITP）的影响因素，为ITP患儿的预后判断及治疗提供依据。
回顾性分析安徽医科大学第二附属医院近5年收治的ITP患儿的临床资料，并进行1年以上随访。根据纳入标准，通过病历系统检索、门诊及电话随访选取符合条件的病例（共328例）。通过单因素及多因素logistic分析得出影响ITP患儿预后的独立影响因素，并评估其对ITP患儿预后的预测价值。
328例ITP患儿中，新诊断ITP 208例（64%），持续性ITP 54例（16%），慢性ITP 66例（20%），1年内缓解率为79.9%。单因素分析结果显示，年龄、发病前感染及疫苗接种史、抗核抗体、初始绝对淋巴细胞计数（ALC）及治疗方案与患儿预后相关（P<0.05）。多因素分析显示，发病前感染及疫苗接种史、初始治疗方案、初始诊断时的ALC是影响ITP患儿预后的独立因素（P<0.05）。初始治疗联合静脉注射免疫球蛋白（IVIG）组血小板恢复至100×10⁹/L的时间短于单纯使用糖皮质激素组（P<0.01）。以慢性病发展（病程>12个月）为状态变量，以ALC或ALC联合既往感染或疫苗接种史为检验变量绘制受试者工作特征（ROC）曲线。结果显示，当淋巴细胞绝对值为3.80×10⁹/L时，曲线下面积最大（0.787），灵敏度为80.6%，特异度为65.53%（P<0.01），联合结果显示曲线下最大面积为0.859，灵敏度为77.61%，特异度为78.41%。
初始治疗方案联合IVIG可降低ITP患儿慢性化的发生，其疗效优于单纯糖皮质激素组（血小板恢复时间更短）；既往感染或疫苗接种史、初始诊断时的ALC是影响ITP患儿预后的独立因素，两者联合对预后有较好的预测价值。
