前瞻性评价2016版ITP出血评分量表在原发免疫性血小板减少症中的应用

发布时间：2018-08-03 13:50

【摘要】：研究背景原发免疫性血小板减少症(ITP)是一种获得性的自身免疫性出血性疾病,国际上采纳过多个出血评分系统用来评价ITP患者出血风险,但均未能获得广泛应用。2013年,ITP国际工作组提出了 ITP特异性出血评价工具(ITP-BAT),目前已成为公认的可用来量化ITP患者出血情况的工具,但因数据采集相对耗时,减弱了其临床实用性。为了简化评估流程、增加临床实践的可操作性,中华医学会血液学分会发布的《成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)》推荐了一个ITP出血评分量表(2016版ITP出血评分量表)。研究目的前瞻性评价2016版ITP出血评分量表的临床应用价值。方法采用2016版ITP出血评分量表和ITP特异性出血评价工具(ITP-BAT)对88例ITP患者进行出血评分,分析血小板计数、性别、疾病分期与2016版ITP出血评分量表评分的关系和两种出血评分系统的一致性。在47例新诊断ITP患者大剂量地塞米松治疗前及治疗后1、2周分别进行2016版ITP出血评分量表评分及血小板计数检查,评估2016版ITP出血评分量表的反应度。结果出血评分和患者血小板计数呈负相关(r=-0.515,P0.001),不同性别、疾病分期患者2016版ITP出血评分量表评分差异无统计学意义(F=4.255,P=0.382;F=5.251,P=0.753)。ITP出血评分量表与ITP-BAT具有很好的一致性。47例ITP患者大剂量地塞米松治疗前后出血评分变化具有统计学意义(z=-5.612,P0.001),治疗后未达到完全反应的患者治疗前后出血评分变化具有统计学意义(z=-3.969,P0.001)。两名医生背靠背评分完全相同的比例为94.4%(κ=0.918)。2016版ITP出血评分量表进行评分所需时间短于ITP-BAT评分系统[3(2～6)min 对 7(4～13)min,z=-8.213,P0.001]。结论2016版ITP出血评分量表在临床应用中具有很好的反应度及评价一致性,与ITP-BAT评分系统具有很好的一致性,且采集信息耗时短,可作为病情判断、风险评估及疗效评价的有效工具。
[Abstract]:Background: primary immune thrombocytopenia (ITP) is an acquired autoimmune hemorrhagic disease. Multiple haemorrhage scoring systems have been adopted internationally to evaluate the bleeding risk of ITP patients. But none of them were widely used. In 2013, the ITP International Task Force proposed the ITP specific Hemorrhage Evaluation tool (ITP-BAT), which is now recognized as a tool for quantifying bleeding in patients with ITP, but because data collection is relatively time-consuming, It weakens its clinical practicability. In order to simplify the evaluation process and increase the operability of clinical practice, The consensus of Chinese experts on diagnosis and treatment of Adult Primary immune Thrombocytopenia (2016 Edition) issued by the Chinese Society of Hematology recommended a ITP Hemorrhage scale (version 2016 ITP Hemorrhage scale). Objective to evaluate prospectively the clinical value of 2016 ITP Hemorrhage scale. Methods Eighty-eight patients with ITP were evaluated with the 2016 ITP Hemorrhage scale and ITP specific Hemorrhage Evaluation instrument (ITP-BAT). The platelet count and gender were analyzed. The relationship between the disease staging and the 2016 ITP bleeding score scale and the consistency between the two bleeding scoring systems. 47 patients with newly diagnosed ITP were evaluated with ITP bleeding score scale (2016) and platelet count (platelet count) before and after treatment with high dose dexamethasone (Dexamethasone). The response of ITP bleeding score scale (2016) was evaluated. Results there was a negative correlation between bleeding score and platelet count (r-0.515, P0.001). There was no significant difference between the 2016 ITP bleeding score scale of patients with disease staging (FF4.255 / 0.382F5.251 / P0.753). There was a good agreement between ITP-BAT and ITP-Hemorrhage score scale. There was statistically significant change of bleeding score in 47 patients with ITP before and after high-dose dexamethasone treatment. There was significant difference in bleeding score before and after treatment in patients with no complete response after treatment (zhi-5.612g P0.001). The ratio of back-to-back score of the two doctors was 94.4% (魏 0.918) .2016 version of ITP bleeding score scale was shorter than that of ITP-BAT scoring system [3 (2 / 6) min vs 7 (413) minzao -8.213g / P0.001]. Conclusion the 2016 ITP haemorrhage score scale has good response and evaluation consistency in clinical application, and is in good agreement with ITP-BAT scoring system, and it can be used as the judgement of the disease because it takes a short time to collect information. Effective tools for risk assessment and efficacy evaluation.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R558.2

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