儿童急性特发性血小板减少性紫癜125例临床分析

Clinical analysis of 125 cases of children with idiopathic thrombocytopenic purpura

目的探讨儿童特发性血小板减少性紫癜(ITP)的临床特征。方法回顾性分析125例ITP住院患儿的临床资料,并对其发病年龄、诱因、出血情况及3种不同治疗方案的治疗效果进行分析。结果 (1)婴幼儿发病多见,其中年龄1个月～1岁者37例(29.6%),～3岁者38例(30.4%),≤3岁占所有病例数的60%;(2)起病诱因不明者67例(53.6%),诱因明确58例(46.4%),12例(9.6%)发病前1个月内有预防接种史;(3)以肾上腺糖皮质激素治疗为主的综合治疗可使出血症状很快消失;治疗后3、7 d的血小板值与治疗前比较差异有显著性(P<0.01)。结论(1)儿童ITP发病年龄以婴幼儿期多见;(2)约半数患儿有前驱感染史,疫苗接种后ITP发生率高于以往报道;(3)泼尼松、泼尼松+静脉注射用人免疫球蛋白治疗以及地塞米松+静脉注射用人免疫球蛋白3种方法治疗儿童ITP均有较好疗效。

Objective To discuss the clinical features of children with idiopathic thrombocytopenic purpura （ITP）. Methods The clinical data of 125 children with ITP and 3 different strategies of therapy were retrospectively analyzed. Results （1）It occurred more commonly in small children, accounting for 60% of all cases, of which 37 cases （29.6%）ranged from one month to one year old, 38 cases （30.4%） ranged from one year to 3 years old. （2） Among all cases, 67（53.6% ）had unclear causes, 58（46.4% ） had clear causes, and 12 cases had vaccination histories within one month. （ 3 ） The bleeding symptoms could be effectively controlled by ACTH. The PLT counts increased dramatically after 3-day and 7-day treatment （P 〈 0.01 ）. Conclusions （ 1 ） Childhood ITP occurred commonly in younger children. （2） More than half cases had prodromal infection histories. The incidence rate of ITP caused by vaccine injection was higher than previous reports. （3） The treatment of ACTH was effective for ITP, including oral prednisone, oral prednisone plus intravenous IVIG and intravenous DXM plus IVIG.