163例成人原发免疫性血小板减少症自身抗体表达特点及预后影响因素分析

Prognosis of adult primary immune thrombocytopenia and its predicting factors

目的分析原发免疫性血小板减少症(primary immune thrombocytopenia,ITP)自身抗体表达及预后影响因素。方法回顾性分析西南医科大学附属医院血液内科2014年1月-2019年3月收治的163例成人ITP住院患者的临床资料,分析其自身抗体表达及预后影响因素。结果163例中,治愈114例,未治愈49例。自身抗体表达阳性48例,女性阳性率为36.3%(37/102),高于男性的18.0%(11/61);年龄≥60岁患者阳性率为41.9%(18/43),高于年龄<60岁患者的25%(30/120),差异均有统计学意义(P<0.05)。单因素分析显示,初诊血小板计数、出血评分、自身抗体、是否应用丙种球白与预后相关(P均<0.05);多因素分析显示,影响预后的独立因素依次为自身抗体阴性(OR=0.142,95%CI:0.060~0.336)、应用丙种球蛋白(OR=8.062,95%CI:2.429~26.763)、出血评分低(OR=6.235,95%CI:1.905~20.402)。结论成人原发免疫性血小板减少症患者自身抗体表达随着年龄增长有增高趋势,女性阳性率高于男性。自身抗体、是否应用丙种球蛋白、出血评分是影响成人ITP预后的独立因素。

Objective To analyze the autoantibody expression and prognostic factors in adults primary immune thrombocytopenia(ITP).Methods Clinical data about 163 patients with ITP admitted to the hematology ward of the affiliated hospital of Southwest Medical University from January 2014 to March 2019 were retrospectively analyzed.The patients were followed up,and the autoantibody expression and factors affecting the prognosis were analyzed.Results Of the 163 cases,114 patients were cured and 49 cases were not cured.Positive expression of autoantibody was found in 48 cases,and the positive rate was higher in female(36.3%,37/102)than that of male(18.0%,11/61),and it was also higher in patients aged≥60 years(41.9%,18/43)than that in patients<60 years(25%,30/120),and these differences were statistically significant(P<0.05,respectively).Univariate analysis showed that initial platelet counts,bleeding score,autoantibody and immunoglobulin treatment were associated with the prognosis of ITP(all P<0.05).Multivariate analysis showed that positive expression of autoantibody(OR,0.142;95%CI,0.060-0.336),lower bleeding score(OR,8.062;95%CI,2.429-26.763)and immunoglobulin treatment(OR,6.235;95%CI,1.905-20.402)were independent factors affecting prognosis(all P<0.01).Conclusion The autoantibody positive rate in adults with primary immune thrombocytopenia is higher in women than that in men,and it increases with age.Autoantibody,immunoglobulin treatment and bleeding score are independent factors affecting the prognosis of adults with primary immune thrombocytopenia.