636例儿童免疫性血小板减少性紫癜临床分析

发布时间：2018-06-29 17:32

本文选题：儿童 + 免疫性血小板减少性紫癜　；参考：《宁夏医科大学》2012年硕士论文

【摘要】：目的分析儿童免疫性血小板减少性紫癜（immune thrombocytopenic purpura，ITP）患者的临床特点；评价临床常用不同治疗方法的疗效；探讨影响ITP患儿由急性免疫性血小板减少性紫癜（AITP）发展为慢性免疫性血小板减少性紫癜（CITP）的可能相关因素，改善ITP患儿的预后。方法收集2001年11月至2011年9月在宁夏医科大学附属总院初诊为ITP的儿童为研究对象，整理相关数据，并运用统计软件进行分析。结果共收集病例636例，男/女为1.35：1。患儿年龄介于1月～15岁，平均年龄为55.4月，均符合儿童ITP诊断标准。春、夏、秋、冬季发病所占比例为21.70%、36.01%、19.18%、23.11%。310例发病1～4周前有感染病史，占48.74%，其中上呼吸道感染230例，占74.19%。103例患儿行病原学检查，70例阳性，阳性率为67.96%。191例患儿发病前有预防接种史，占30.03%。病例分为1岁组、1～岁组、3～岁组、7～岁组及10～岁组，比例分别为27.04%、19.97%、29.40%、12.42%、11.16%，各年龄组男、女性别差异无统计学意义，但是10～岁组中女孩比例明显增加，为64.79%。456例患儿行骨髓细胞学（BM）检查，23.25%巨核细胞（MK）总数正常，其余患儿中约3/4的MK明显增高，以原始幼稚型和颗粒型MK为主，，而产血小板型少见甚至缺如。采用秩和检验对各年龄组疗效进行统计分析，各年龄组疗效差异有统计学意义，同时仅3～岁组内不同治疗方法疗效差异有统计学意义。利用Logistic回归模型多因素分析，提示糖皮质激素+IVIG联合治疗、病程、对症支持治疗、年龄、血小板上升正常时间及颗粒型MK可作为儿童AITP转为CITP的独立危险因素。结论1.儿童ITP以AITP多见，多发于冬季、夏季，多有感染及疫苗接种史，男孩发病数较女孩高，小于1岁及3～7岁的儿童多发。2.临床表现以皮肤黏膜出血为主，严重的危及生命的出血少见。3.BM检查以MK增多为主，多伴有成熟障碍，其中原始幼稚型及颗粒型MK升高多见，产板型MK减低甚至缺如。4.需依据患儿病情拟定治疗方案，及时控制病情并提升PLT。5.糖皮质激素和IVIG为儿童ITP的常用一线治疗，多数患儿疗效较好。6.有明确感染史及病原学检查阳性的患儿疗效较好，年龄大患儿疗效较差。7.糖皮质激素+IVIG联合治疗、病程、对症支持治疗、年龄、血小板上升至正常时间及颗粒型MK可作为儿童AITP转为CITP的独立危险因素。
[Abstract]:Objective to analyze the clinical characteristics of children with immune thrombocytopenic purpura (immune thrombocytopenic purpura), and to evaluate the efficacy of different treatment methods. To explore the possible factors influencing the development from acute immune thrombocytopenic purpura (AITP) to chronic immune thrombocytopenic purpura (CITP) in children with ITP, and to improve the prognosis of children with ITP. Methods Children who were newly diagnosed as ITP in affiliated General Hospital of Ningxia Medical University from November 2001 to September 2011 were collected and analyzed by statistical software. Results 636 cases were collected, male / female was 1.35: 1. The age of the children ranged from 15 to 15 years old in January, and the average age was 55.4 months. All the children were in accordance with the diagnostic criteria of ITP in children. The incidence rate in spring, summer, autumn and winter was 21.700.36.01and 19.18. 310 cases had a history of infection 4 weeks before onset, accounting for 48.74. of them, 230 cases were upper respiratory tract infection, 70 cases were positive for etiology examination, and the positive rate was 67.96.191 cases had history of prophylactic inoculation before onset. 30.03%. The cases were divided into 1 year old group, 1 year old group, 3 ~ year old group, 7 ~ year old group and 10 ~ year old group, the proportion of them were 27.04, 19.97 and 29.40 respectively. There was no significant difference between male and female in each age group, but the proportion of girls in 10 ~ year old group increased obviously. Bone marrow cytology (BM) examination showed that the total number of megakaryocytes (MK) was normal in 64.79 and 456 children. About 3 / 4 of MK in other children were significantly increased, mainly in primitive infantile type and granular type, but platelet-producing type was rare or absent. Rank sum test was used to analyze the curative effect of each age group. The difference of curative effect was statistically significant in each age group, and there was statistical significance only in 3 ~ year old group. The multivariate analysis of logistic regression model suggested that the combination of glucocorticoid IVIG therapy, course of disease, symptomatic support therapy, age, normal time of platelet rise and granular MK could be independent risk factors for the conversion of AITP to CITP in children. Conclusion 1. AITP was more common in children, mostly in winter and summer, and had more history of infection and vaccination. The incidence of ITP in boys was higher than that in girls, and it was more common in children younger than 1 year old and 3 ~ 7 years old. The clinical manifestations were mainly skin and mucosal hemorrhage, and the severe life-threatening hemorrhage was rare. 3. The increase of MK was main in BM examination, and most of them were accompanied with mature disorder. Among them, the increase of MK in primitive infantile type and granular type, and the decrease or even absence of MK in plate-producing type. According to the condition of the child, the treatment plan should be drawn up, and the disease should be controlled and PLT.5. Glucocorticoid and IVIG are common first line treatment of ITP in children. Children with definite history of infection and positive etiological examination had better curative effect, while the older children had a poor curative effect. 7. 7. Combined therapy of glucocorticoid IVIG, course of disease, treatment of symptomatic support, age, time of platelet rise to normal and granular MK may be the independent risk factors for the conversion of AITP to CITP in children.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.5

【参考文献】