影响腹腔镜脾切除治疗免疫性血小板减少性紫癜疗效的多因素分析

Multivariate analysis of the efficacy of laparoscopic splenectomy in the treatment of immune thrombocytopenic purpura

目的 探讨腹腔镜脾切除（LS）治疗免疫性血小板减少性紫癜（ITP）疗效的影响因素.方法 对2007年1月至2012年9月78例行LS的ITP患者临床资料进行回顾性分析,根据术后疗效分为有效组和无效组,对9项影响因素进行单因素及多因素分析.结果 在有效组（65例）与无效组（13例）患者中,术前1d中位血小板计数分别为47×109/L和21×109/L,平均手术时间分别为（166±46） min和（139±29） min.单因素分析结果显示,2组患者间术前1d血小板计数（Z=-2.776,P =0.005）及手术时间（t=2.723,P=0.011）差异有统计学意义.多因素分析结果显示,术前1d血小板计数是预测LS治疗ITP疗效的有效指标（OR=0.964,95％ CI：0.932 ～0.997,P=0.031）,而手术时间并非有效指标（P=0.051）.结论 术前1d血小板计数是一项能有效预测LS治疗ITP疗效的指标.但各种影响因素能否真正起到预测LS治疗ITP疗效的作用,还需进一步通过大样本、多中心、前瞻性研究加以验证.

Objective To identify factors that can effectively predict the efficacy of laparoscopic splenectomy （LS） in the treatment of immune thrombocytopenic purpura （ITP）.Methods From January 2007 to September 2012,78 patients with ITP underwent laparoscopic splenectomy were retrospectively analyzed.According to the postoperative platelet （PLT） count and haemorrhagic manifestations,they were divided into effective group and ineffective group.Nine influencing factors were univariate analyzed and multivariate analyzed.Results In effective group （65 cases） and ineffective group （13 cases）,average PLT count of 1 day before surgery was 47 × 109/L vs.21 × 109/L,average operative time was （166 ±46） minutes vs.（139 ± 29） minutes.Univariate analysis result：PLT count of 1 day before surgery （Z =-2.776,P =0.005） and operative time （t =2.723,P =0.011） was statistically significant in 2 groups,the rest factors did not significantly influence the result.Multivariate analysis revealed that only PLT count of 1 day before surgery was statistically significant （OR =0.964,95% CI：0.932-0.997,P =0.031） in 2 groups,but operative time （P =0.051） was not statistically significant.Conclusions PLT count of 1 day before surgery is a predict factor in LS for ITP.Because of the limited sample number,further multi-center prospective study with large sample is warrant.