婴幼儿与3岁以上儿童特发性血小板减少性紫癜的临床对比

Comparison study of idiopathic thrombocytopenic purpura in the children below 3 years old with above 3 years old

目的比较婴幼儿与3岁以上儿童特发性血小板减少性紫癜(ITP)的临床特征、短期治疗反应及疗效。方法收集2006年10月至2008年10月在重庆医科大学附属儿童医院首次诊断并接受相应治疗的ITP患儿190例,按年龄分为婴幼儿组和3岁以上儿童组,回顾性分析比较两组ITP患儿的临床特征和疗效。结果(1)婴幼儿组男性患儿所占比例高于3岁以上儿童组,差异有统计学意义(P=0.031)。(2)婴幼儿组以病毒性肠炎为诱因的比例显著高于3岁以上儿童组,差异有统计学意义(P=0.001);婴幼儿组以疫苗接种为诱因的比例显著高于3岁以上儿童组,差异有统计学意义(P=0.045)。(3)婴幼儿组鼻衄发生率显著低于3岁以上儿童组,差异有统计学意义(P<0.001);婴幼儿组失血性贫血发生率显著低于3岁以上儿童组,差异有统计学意义(P=0.001)。(4)EB病毒(EBV)-IgM和巨细胞病毒(CMV-IgM)血清学阳性率在婴幼儿组与3岁以上儿童组比较,差异有统计学意义(P=0.016,P<0.001)。(5)婴幼儿组骨髓巨核细胞中位数和增高比例均显著低于3岁以上儿童组,差异有统计学意义(Z=2.804,P=0.005;χ2=10.011,P=0.002)。(6)激素组婴幼儿血小板升至正常时间显著短于3岁以上儿童组,差异有统计学意义(P<0.001);激素+丙种球蛋白组(丙球)婴幼儿血小板升至正常时间显著短于3岁以上儿童组,差异有统计学意义(P<0.001);激素组和激素+丙球组中,婴幼儿短期疗效都分别显著好于3岁以上儿童组,差异有统计学意义(P=0.0410,P=0.0075)。结论婴幼儿与3岁以上儿童ITP比较,男性比例高,出血部位单一、出血程度轻。疫苗接种与病毒性肠炎是重要诱因,巨细胞病毒感染可能在婴幼儿ITP的发生中起着重要作用。巨核细胞中位数及增高比例低,治疗后血小板上升速度快、短期疗效好。激素与激素+丙球治疗均能有效的提升血小板的数量,激素+丙球治疗血小板上升速度快于单用激素治疗。

Objective To study the clinical features of pediatric patients with idiopathic thrombocytopenic purpura （ITP） from infancy to adolescence, and compare their treatment response and the effects. Methods The data of the ITP children diagnosed and administrated between 2006 - 2008 were collected and analyzed by soft ware SPSS 12.0. The patients were divided into infant group （〈 3 years old） and elder group （〉 3 years old）. The gender, demographic infor- mation, platelet count at the diagnosis, bleeding and anemia, virus infection and megakaryocytes, and most importantly, the treatment response were evaluated. Results （ 1 ）The percentage of the male in infant group （66%） was statistically higher than that （50.6%）in the elder group （ P = 0.031 ）. （2） The incidence of epistaxis in the infant group （9.7% , n = 10） was statistically lower than that （43.7%） in the elder group （P 〈 0.001）. The incidence of bleeding-eaused anemia in the infant group （11.7% ） was statistically lower than that （43.7%） in the elder children （P = 0.001 ）. （3） The incidence of viral enteritis as a motivation in the infant group （14.56%.） was statistically higher than that （ 1.15% ） in the elder group （P = 0.001 ） ; the incidence of vaccine inoculation as a motivation in the infant group （8.74%） was statistically higher than that （ 1.15% ） in the elder group （P = 0.045）. About 32.32% was cytomegalovirus-positive in the infant group while 2.35% in the elder group （P 〈 0.001 ）. （g）The percentage of EB virus positive in infant group （4.04%） was statistically lower than that（ 14.12% ） in the elder patients （P = 0.016）. （5）Both the median and the increase ratio of megakrocytes in infant group （ 144,81.7% ）were statistically lower than that （280,96.6%）in the elder group （P = 0.005; P = 0.002）. （6）Under the treatment of steroids only, the time for the platelet to become normal in infant group （7.1 ±2.6） was statistically shorter than that（10.3±3.2） in the elder children（P 〈 0.001 ）. Under the treatment of steroids plus IVIG, the time for the platelet to become normal in infant group （4.4±1.3） was statistically shorter than that （7.9±2.8） in the elder group （P 〈 0.001 ）. The treatment efficacy by steroids plus IVIG in infant group was also statistically better than that in the elder group （P = 0.0075 ）. Conclusion The characteristics of the infant patients with ITP are different from those of the elder patients. These include higher male/female ratio, different motivation and virus infection, fewer and lighter bleeding sites, lower number of megakrocytes in bone marrow, faster platelet count recovery, and most importantly, better treatment efficacy. Steroids plus IVIG treatment results in a faster recovery of platelets.