儿童免疫性血小板减少症112例临床特征分析

发布时间：2018-09-09 16:17

【摘要】：目的:分析儿童免疫性血小板减少症(immune thrombocytopenia,ITP)临床特征及疗效,分析中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)在儿童ITP的诊断价值。方法:收集2006年1月至2016年10月间在本院儿科住院治疗的共112例ITP病例,分析临床特征。将中度以上血小板减少的患儿分为丙种球蛋白低剂量(1.2g/kg)和高剂量组(2g/kg),两组均给予地塞米松联合治疗,分析其疗效。以同年龄段正常儿童的NLR作为对照组,分析入院时NLR对儿童ITP的诊断价值。结果:112例ITP患儿年龄在1月～14岁,平均年龄为42.4月,发病年龄5岁占76.8%,各年龄组男、女性别无明显统计学差异。春、冬季节发病率较夏、秋季节高(P0.05)。79例(70.5%)初诊血小板计数30×109/L。46例(41%)发病前1～3周有急性感染病史,其中上呼吸道感染42例(37.5%),肠道感染4例(3.5%);11例(9.82%)发病前有疫苗接种史。皮肤淤点淤斑108例(96.4%),口腔黏膜出血25例(22.3%),鼻出血8例(7.1%),牙龈出血4例(3.5%),眼结膜出血和便血各2例(1.8%),血尿1例(0.9%)。两组治疗后血小板计数与治疗前相比均有明显统计学差异,两组疗效无明显统计学差异。入院时ITP患儿NLR(0.75±0.59)和正常组儿童NLR(0.76±0.36)比较无明显统计学差异。结论:1.儿童ITP多发于春、冬季,发病前多有上呼吸道感染史,男女发病率无明显差异,5岁以内儿童多发。2.多数ITP患儿发病时血小板计数30×109/L,临床表现以皮肤黏膜出血为主。3.采用低剂量和高剂量丙种球蛋白治疗儿童ITP的短期疗效无明显差异。4.入院时NLR对儿童ITP的诊断无参考意义。
[Abstract]:Objective: to analyze the clinical characteristics and curative effect of immune thrombocytopenia (immune thrombocytopenia,ITP) in children, and to analyze the diagnostic value of neutrophil to lymphocyte ratio (neutrophil to lymphocyte ratio,NLR) in children with ITP. Methods: 112 cases of ITP were collected from January 2006 to October 2016, and the clinical features were analyzed. Children with moderate thrombocytopenia were divided into two groups: low dose of globulin (1.2g/kg) and high dose group (2g/kg). Both groups were treated with dexamethasone. NLR of normal children of the same age was used as control group to analyze the diagnostic value of NLR in children with ITP at admission. Results one hundred and twelve children with ITP were 14 years old in January, with an average age of 42.4 months. The age of onset was 5 years old (76.8%). There was no significant difference between male and female in all age groups. The incidence in spring and winter was higher than that in summer, and the incidence of acute infection was higher in autumn (P0.05) .79 cases (70.5%) than that in summer. The platelet count of 30 脳 109/L.46 (41%) had a history of acute infection 1 week before onset. 42 cases (37.5%) of upper respiratory tract infection and 11 cases (9.82%) of intestinal infection had a history of vaccination before the onset of the disease, including 42 cases (37.5%) of upper respiratory tract infection, 4 cases (3.5%) of intestinal infection and 11 cases (9.82%) of intestinal infection. There were 108 cases (96.4%) of skin stasis spots, 25 cases (22.3%) of oral mucosal hemorrhage, 8 cases (7.1%) of epistaxis, 4 cases (3.5%) of gingival bleeding, 2 cases (1.8%) of conjunctival hemorrhage and 1 case (0.8%) of hematuria, and 1 case (0.9%) of hematuria. There was significant difference in platelet count between the two groups after treatment, and there was no significant difference in curative effect between the two groups. There was no significant difference in NLR between ITP children (0.75 卤0.59) and normal children (0.76 卤0.36) at admission. Conclusion 1. ITP was more common in spring and winter, and had a history of upper respiratory tract infection before onset. There was no significant difference in incidence of ITP between male and female children under 5 years old. The platelet count was 30 脳 10 9 / L in most ITP children, and the clinical manifestations were mainly skin and mucosal hemorrhage. 3. 3. There was no significant difference between low dose gamma globulin and high dose gamma globulin in the treatment of children with ITP. At admission, NLR has no reference value in the diagnosis of ITP in children.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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