Dan Cristina Ana-Maria, Sima Laurențiu Vasile, Dan Radu Georghe, Ioniță Ioana, Crețu Octavian Marius, Brează Gelu Mihai, Sima Alexandra Christa, Ioniță Claudiu
Doctoral School, "Victor Babeș" University of Medicine and Pharmacy, 30041 Timișoara, Romania.
Clinic of Surgical Semiology, "Victor Babeș" University of Medicine and Pharmacy, 30041 Timișoara, Romania.
Medicina (Kaunas). 2025 Mar 24;61(4):578. doi: 10.3390/medicina61040578.
Immune thrombocytopenic purpura (ITP) is a rare hematological disorder characterized by an autoimmune-mediated decline in platelet count in peripheral blood. Over the years, its treatment has evolved, leading to a decline in the role of splenectomy, which was previously used as a second-line therapy. This study aims to evaluate the effects of spleen removal on the progression of the disease, regardless of the surgical procedure, by presenting a single-center experience. We retrospectively reviewed the medical records of all ITP patients who underwent splenectomy and were admitted to the Hematology Clinic of Timișoara Emergency City Hospital between January 1988 and June 2024. A total of 217 ITP patients who underwent splenectomy were identified over a 37-year period. Demographic data, postoperative complications, and responses to splenectomy were analyzed over a median follow-up period of 93.86 ± 104.25 months, ranging from 6 to 423 months. Among the 217 patients included in the study, 155 (71.42%) were female and 62 (28.58%) were male, with a mean age of 38.47 ± 16.12 years. During the follow-up period, a significant decrease in the number of splenectomies was observed ( < 0.001). The overall morbidity rate was 14.28%. The overall response rate after splenectomy was 85.71%, with 158 patients (72.81%) achieving a complete response and 28 (12.90%) achieving a partial response. However, 28 (15.05%) of the responsive patients experienced relapse during follow-up and required additional medical therapy. Analyzing the association between comorbidities and relapse after splenectomy, the presence of diabetes (OR = 6.90, 95% CI: 2.87-16.58), hepatic diseases (OR = 64.60, 95% CI: 19.60-212.91), immune thyroid disorders (OR = 8.37, 95% CI: 2.09-33.46), and obesity (OR = 10.22, 95% CI: 3.41-30.60) were identified as risk factors for relapse using univariate analysis. Splenectomy remains the treatment with the best long-term outcomes compared to other therapies. However, concerns about early and late complications following splenectomy, along with advancements in modern ITP treatments, have led to a significant decline in the number of splenectomies performed. In univariate analyses, female gender, age over 40, and the presence of diabetes, hepatic diseases, obesity, or immune thyroid disorders were found to be risk factors for relapse following splenectomy. In the logistic regression analysis adjusted for age and sex, obesity and steatosis were significantly associated with an increased risk of relapse after splenectomy in women over 40 years of age.
免疫性血小板减少性紫癜（ITP）是一种罕见的血液系统疾病，其特征是外周血中血小板计数因自身免疫介导而下降。多年来，其治疗方法不断演变，导致脾切除术的作用有所下降，脾切除术此前曾被用作二线治疗方法。本研究旨在通过介绍单中心经验，评估脾切除对疾病进展的影响，而不考虑手术方式。我们回顾性分析了1988年1月至2024年6月期间在蒂米什瓦拉市急诊市立医院血液科住院并接受脾切除术的所有ITP患者的病历。在37年的时间里，共确定了217例接受脾切除术的ITP患者。在中位随访期93.86±104.25个月（范围为6至423个月）内，分析了人口统计学数据、术后并发症以及脾切除术后的反应。在纳入研究的217例患者中，155例（71.42%）为女性，62例（28.58%）为男性，平均年龄为38.47±16.12岁。在随访期间，观察到脾切除术的数量显著减少（<0.001）。总体发病率为14.28%。脾切除术后的总体缓解率为85.71%，其中158例患者（72.81%）达到完全缓解，28例（12.90%）达到部分缓解。然而，28例（15.05%）缓解患者在随访期间复发，需要额外的药物治疗。通过单因素分析，发现糖尿病（OR=6.90，95%CI：2.87-16.58）、肝脏疾病（OR=64.60，95%CI：19.60-212.91）、免疫性甲状腺疾病（OR=8.37，95%CI：2.09-33.46）和肥胖（OR=10.22，95%CI：3.41-30.60）是复发的危险因素。与其他治疗方法相比，脾切除术仍然是具有最佳长期疗效的治疗方法。然而，对脾切除术后早期和晚期并发症的担忧，以及现代ITP治疗方法的进步，导致脾切除术的实施数量显著下降。在单因素分析中，发现女性性别、40岁以上年龄以及糖尿病、肝脏疾病、肥胖或免疫性甲状腺疾病的存在是脾切除术后复发的危险因素。在根据年龄和性别进行调整的逻辑回归分析中，肥胖和脂肪变性与40岁以上女性脾切除术后复发风险增加显著相关。
