儿童原发性免疫性血小板减少症慢性化的相关危险因素分析

发布时间：2019-05-23 23:47

【摘要】：目的:探讨儿童原发性免疫性血小板减少症(immune thrombocytopenic purpura,ITP)慢性转化的的危险因素。方法:选择2014年1月至2016年1月在青大附院血液儿科初诊住院的原发性免疫性血小板减少症患儿进行随访,将有效随访大于1年的患儿为研究对象,分为非慢性组和慢性组。采用回顾性分析方法对有效随访的原发性免疫性血小板减少症患儿的临床资料进行统计处理,分析非慢性原发性免疫性血小板减少症(non-chronic immune thrombocytopenic purpura,NCITP)与慢性原发性免疫性血小板减少症(chronic immune thrombocytopenic purpura,CITP)在发病年龄、性别、可能感染的诱因、初诊时病程、初诊时血小板计数、初诊时淋巴细胞绝对数、调节性淋巴细胞亚群、骨髓巨核细胞方面有无差异。结果:共收集有效随访病例183例,男105例,女78例。年龄在1个月至13岁1个月之间,中位年龄3岁6个月。CITP患儿48例,占26.2%;NCITP患儿135例,占73.8%。CITP组中大于3岁发病的患儿比例大于NCITP组,分别占77.1%和56.3%,两组间差异有统计学意义(χ2=6.476,P=0.011);CITP组初诊时病程大于NCITP组[(5±3.53)天对(3.56±3.06)天,t=-2.696,P=0.008];CITP组初诊时血小板计数低于NCITP组[(22.15±16.26)×109/l对(31.61±22.21)×109/l,t=2.703,p=0.008];CITP组中骨髓巨核细胞总数≥100个的患儿比例大于NCITP组,分别为81.2%和61.5%,两组间差异有统计学意义(χ2=6.227,P=0.013);CITP组初诊时淋巴细胞绝对数小于NCITP组[(2.88±1.06)×109/l对(4.07±2.23)×109/l,t=3.550,P=0.000];CITP组外周血中调节T细胞的百分比低于NCITP组[(2.50±1.32)%对(3.27±1.60)%,t=2.396,P=0.019];CITP组CD4+T辅助细胞百分比低于NCITP组[(31.58±8.39)%对(34.66±8.81)%,t=2.112,P=0.036];CITP组CD4/CD8T细胞比值低于NCITP组[(1.28±1.60)对(1.56±0.68)%,t=2.55,P=0.012]。两组间外周血CD8+T抑制细胞、CD19B细胞、NK细胞、活化T细胞、活化B细胞、性别、可能感染诱因、骨髓巨核细胞分化类型比例无统计学差异。对有意义的因素行非条件logistic回归分析,初诊时病程的回归系数为0.252,wald检验结果P=0.009,有统计学差异,OR值为1.287;初诊时淋巴细胞绝对数的回归系数为-0.556,wald检验结果P=0.005,有统计学差异,OR值为0.573;调节T细胞比例的回归系数为-0.545,wald检验结果P=0.018,有统计学差异,OR值为0.580。对以上3个独立危险因素行ROC分析确定其临界值,初诊时淋巴细胞绝对数为3.03×109/l,敏感度为64.6%,特异度为60.7%;调节T细胞比例为2.03%,敏感度为78.9%,特异度为51.5%;初诊时病程为3.5天,敏感度为54.2%,特异度为65.9%。结论:1.慢性ITP大于3岁发病的患儿比例大于非慢性ITP患儿,慢性ITP患儿初诊时病程大于非慢性ITP患儿,慢性ITP患儿初诊时淋巴细胞绝对数小于非慢性患儿,慢性ITP患儿调节T细胞比例小于非慢性ITP患儿,慢性ITP患儿CD4/CD8比值小于非慢性ITP患儿。2.初诊时病程、初诊时淋巴细胞绝对数、调节T细胞比例为儿童ITP慢性化的独立危险因素。
[Abstract]:Objective: to investigate the risk factors of chronic transformation in children with primary immune thrombocytopenia (immune thrombocytopenic purpura,ITP). Methods: from January 2014 to January 2016, the children with primary immune thrombocytopenia were followed up in the Department of Hematology, affiliated Hospital of Youth University. The children with effective follow-up for more than 1 year were divided into non-chronic group and chronic group. The clinical data of children with primary immune thrombocytopenia were statistically analyzed by retrospective analysis, and the non-chronic primary immune thrombocytopenia (non-chronic immune thrombocytopenic purpura,) was analyzed. NCITP) and (chronic immune thrombocytopenic purpura,CITP) in the age of onset, sex, the inducement of possible infection, the course of first diagnosis, platelet count at first diagnosis, absolute number of lymphocytes at first diagnosis, There were no differences in regulatory lymphocyte subsets and megakaryocytes in bone marrow. Results: 183 cases, 105 males and 78 females, were collected. Between 1 month and 13 years old and 1 month old, the median age was 3 years and 6 months. There were 48 children with CITP, accounting for 26.2%. There were 135 children with NCITP, the proportion of children over 3 years old in 73.8%.CITP group was higher than that in NCITP group (77.1% and 56.3%, respectively). There was significant difference between the two groups (蠂 2 鈮，

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