儿童新诊断免疫性血小板减少症的临床特征分析

发布时间：2018-07-16 15:28

【摘要】：目的:根据目前国内外关于免疫性血小板减少症(immune thrombocytopenia,ITP)的诊疗建议,通过总结我院94例新诊断ITP患儿的相关病历资料,分析新诊断ITP患儿的临床特征,为制定更好的临床诊治策略提供依据。方法:查阅2014年01月至2016年12月于大连医科大学附属第二医院儿科收治的94份资料完整的新诊断ITP患儿临床资料,记录其临床特征等相关数据。运用统计学软件对患儿性别、年龄、起病时间、诱因、临床表现、初诊血小板计数、骨髓细胞学结果、治疗前后的血小板参数等数据进行统计学描述和分析。结果:1、本研究中患儿男:女比例为1:1.14;0~3岁婴幼儿占46.81%,3岁前男孩的患病率大于7岁后(P=0.003)、7岁前女孩的发病率低于7岁以后(P=0.020);发病时间在春、夏、秋、冬四季分别占34.04%、34.04%、17.02%、14.90%(P=0.001)。2、有82例患儿起病前有诱因,感染者70例(85.36%),其中上呼吸道感染者占71.43%(n=50);婴儿、幼儿、学龄前和7~14岁四个年龄段以感染为诱因的概率无明显差别(P=0.164);婴幼儿组EB病毒及肺炎支原体感染率低于3岁以上儿童组,差异有统计学意义(P=0.045、P=0.684)。3、本研究中患儿以轻度出血(56.82%)及极重度血小板减少(44.68%)多见,血小板计数在不同出血程度之间的差别无统计学意义(P=0.789)。4、在于我院行骨髓细胞学检查的75例患儿中,以骨髓巨核细胞数增多者为主(n=64),不同类型的巨核细胞以原始幼稚型和颗粒型所占比例偏高,分别为11.43%和67.47%。5、不同血小板计数之间巨核细胞数目差异无统计学意义(P0.05),而产板型巨核细胞数之间差异有统计学意义(P0.05)。6、治疗前后的5项血小板参数指标的差异均有统计学意义(P0.05)。结论:1、儿童新诊断ITP在3岁前男孩多发,而7岁以后则女孩多见;春、夏季多发。2、感染是儿童新诊断ITP最常见的诱因,各年龄段患儿以感染为诱因的概率无明显差别;EB病毒、肺炎支原体感染可能是3岁以上儿童ITP发病的诱因。3、不同出血程度之间的血小板计数无明显差别,治疗上应更重视临床表现而非血小板计数。4、ITP患儿骨髓细胞学检查结果以巨核细胞数目增多为主,其中原始幼稚型及颗粒型巨核细胞升高多见。5、不同血小板计数间巨核细胞数目无明显差异,血小板计数越低,产板型巨核细胞数目越少。6、ITP患儿血小板参数在治疗前后的改变明显,与治疗前相比,PLT、PCT升高明显。
[Abstract]:Objective: according to the suggestions of diagnosis and treatment of immune thrombocytopenia at home and abroad, the clinical features of 94 newly diagnosed children in our hospital were analyzed. To provide the basis for making better clinical diagnosis and treatment strategy. Methods: from January 2014 to December 2016, 94 newly diagnosed children with ITP were collected from pediatrics department of the second affiliated Hospital of Dalian Medical University and their clinical data were recorded. The data of sex, age, onset time, inducement, clinical manifestation, platelet count at first visit, bone marrow cytology, platelet parameters before and after treatment were described and analyzed by statistical software. Results in this study, the ratio of male to female was 1: 1.140.The prevalence rate of boys before 3 years old was higher than that after 7 years old (P0. 003) and the incidence rate of girls before 7 years old was lower than that after 7 years old (P0. 020), and the onset time was in spring, summer, autumn, and in spring, summer and autumn, the incidence rate of children before 7 years old was lower than that after 7 years old (P0. 020). The four seasons in winter accounted for 14.90% (P0. 001) and 14.90% (P < 0. 001), respectively. There were 82 cases with inducement, 70 cases (85. 36%) infected with infection, 71.43% (n = 50) of upper respiratory tract infection, There was no significant difference in the probability of infection as an inducement between preschool and 7- and 14-year-olds (P0. 164), and the infection rates of Epstein-Barr virus and Mycoplasma pneumoniae in infants and infants were lower than those in children over 3 years of age. The difference was statistically significant (P0. 045 / P0. 684). 3. Mild hemorrhage (56.82%) and extremely severe thrombocytopenia (44.68%) were more common in this study. There was no significant difference in platelet count between different bleeding degrees (P0. 789). The number of bone marrow megakaryocytes increased mainly (nnm64), and the proportion of different types of megakaryocytes was higher than that of primitive type and granular type. The number of megakaryocyte in different platelet count had no significant difference (P0.05), while the number of plate-producing megakaryocyte was significantly different (P0.05). There were significant differences in 5 platelet parameters before and after treatment (P0.05). ConclusionTwo one, children with newly diagnosed ITP were more common in boys before 3 years old than in girls after 7 years of age, infection was the most common inducement of new diagnosis of ITP in children in spring and summer, and there was no significant difference in the probability of infection as inducement of EBV in children of all ages. Mycoplasma pneumoniae infection may be the cause of ITP in children over 3 years old. There is no significant difference in platelet count among different bleeding degrees. In treatment, more attention should be paid to clinical manifestations rather than to platelet count. The results of bone marrow cytology in children with ITP were mainly the increase of megakaryocyte number. The number of megakaryocytes in primitive immature type and granulosa type was higher than that in primitive type. 5. There was no significant difference in the number of megakaryocytes among different platelet counts, and the lower the platelet count, the lower the number of megakaryocytes. The smaller the number of platelet-producing megakaryocytes, the more significant changes of platelet parameters were before and after treatment, and the increase of PLT PCT was significant compared with that before treatment.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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