儿童特发性血小板减少性紫癜急性转慢性危险因素分析

Risk factors of acute idiopathic thrombocytopenic purpura developing into chronic idiopathic thrombocytopenic purpura

目的探讨影响小儿急性特发性血小板减少性紫癜(AITP)发展成慢性特发性血小板减少性紫癜(CITP)的危险因素。方法选择2006年5月至2010年4月于广西医科大学一附院诊断AITP住院患儿138例,对患儿临床表现、实验室检查、治疗方案等16个相关因素分别进行单因素成组对照研究。对有意义的单因素,再运用非条件Logistic多因素回归模型分析,以期找到有意义的因素。结果病程(患儿起病至治疗时间)、ORh(D)+型血、用含有大剂量丙种球蛋白的治疗方案、血小板上升正常时间都是影响AITP患儿转为慢性的主要因素,而与发病年龄、治疗初用血小板、血小板开始回升时间、性别、有无前驱显性感染、治疗前血小板数、血小板平均体积、血小板平均分布系数、骨髓巨核细胞数、幼稚巨核细胞数、颗粒型巨核细胞数、有无幼稚淋巴细胞数无关。结论 AITP患儿早期治疗时用有大剂量丙种球蛋白的治疗方案是改善预后的关键,治疗时血小板回升正常时间晚、ORh(D)+血型(相对于A和B血型)是转为慢性的高危因素。

Objectives To investigate the risk factors for children with acute idiopathic thrombocytopenic purpura （AITP） developing into chronic idiopathic thrombocytopenic purpura （CITP）. Methods A total of 138 patients with AITP from May 2006 to April 2010 in the First Affiliated Hospital of Guangxi Medical University were Selected and telephoned for retrospective analysis. The 16 related factors, including clinical presentation, laboratory tests and treatment programs, were performed single case-control study. For those significant single factors, multi-factor non-conditional Logistic regression analysis was used to find meaningful factors. Results The main influencing factors were the onset-to-treatment time, O Rh （D） ＋ type blood, treatment with gamma globulin and platelets increasing to normal time. The age of onset, early treatment with platelets, platelets beginning-to-pick-up time, gender, with or without the precursor dominant infection, pretreatment platelet count, mean platelet volume, mean platelet distribution coefficient, the number of bone marrow megakaryoeytes, and the number of immature megakaryocytes, the number of particle-type giant cells and naive lymphocytes were irrelavant factors. Conclusion The key to improving the diagnosis includes early treatment, and early treatment with large dose of gamma globulin treatment. The high-risk factors to chronic include lateness of platelet recovery to normal and O Rh （D） ＋ blood （relative to A and B blood type）.