促血小板生成素在儿童ITP发病及预后中的作用探讨

Study on the Role of Thrombopoietin in Occurrence and Prognosis of Children ITP

目的探讨免疫性血小板减少症(ITP)患儿促血小板生成素(TPO)水平与疾病初发状态的相关性;对不同预后组的患儿进行危险因素研究,并分析TPO与其他血小板生发指标的关系,了解TPO在儿童ITP发展中的作用。方法收集2008年9月14日至2012年12月31日期间我院住院治疗ITP患儿的临床资料,检测患儿入院时TPO水平。根据入院时病程分为初发组和非初发组;按疾病转归分为新诊断组、持续性组和慢性组。对初发ITP患儿TPO水平与诊断时血小板计数(PLT)和巨核细胞(MK)计数做相关性分析,了解TPO对疾病发病的作用;分别对不同疾病转归组进行疾病进展危险因素及TPO与MK相关性的分析。结果病例100例,初发组39例,非初发组61例。初发ITP TPO与MK计数的相关性分析r=-0.324,P=0.044,二者呈中度负相关;TPO与PLT无显著相关性(P>0.05)。新诊断组39例,持续性组32例,慢性组29例,各组间TPO水平无统计学差异(P>0.05)。对疾病预后影响因素的分析发现TPO与疾病新诊断状态可能有相关性(P=0.039,但OR值为0.999,95%CI包含1.000);不同预后组中TPO与MK计数的相关性分析仅提示在新诊断和持续性组TPO与MK计数的r=-0.258,P=0.030,二者呈低度负相关。结论 TPO在儿童ITP发生发展中起到了一定作用:初发时TPO水平与MK计数存在负调控关系。12月内获得缓解的病人TPO与MK计数呈低度负相关,提示TPO与MK数量可能共同参与了疾病的进展,其相互关系有待进一步探讨。

Objective To explore effect of thrombopoietin （TPO） on occurrence of children immune thrombocytopenia （ITP）. To know TPO＇ s effect on development of children ITP by looking for risk factors in ITP＇ s prognosis and analysis relationship between TPO and other indicators related to platelet production in different prognosis groups. Methods We gathered clinical datum of patients admitted in our hospital from Sept. 14th. 2008 to Dec. 31st. 2012,and tested their TPO levels. We divided them into 2 groups depending on course of disease： initial-onset group and non-initial-onset group; we also diveded patients into 3 groups according to their prognosis： newly-diagnosed group, persistent group and chronic group. We did correlation analysis between TPO and PLT/ MK, to figure out TPO＇ s effect on occurrence of ITP. We analysed risk fac- tors risk in ITP＇ s prognosis and analysis relationship between TPO and other indicators related to platelet pro- duction in different prognosis groups. Results 100 cases were enrolled, 39 cases were in initial-onset group, 61 cases in the other group. There was negative correlation between TPO and MK（ r = -0. 324,P =0.044） , whereas no correlation betweetn TPO and PLT（P 〉 0.05 ）. 39 cases were in newly-diagnosed group,32 cases were in persistent group and 29 cases were in chronic group,there was no statistical difference in 3 groups（P 〉 0.05 ）. Single- factor logistic regression study showed TPO may be the risk factor in ITP＇ s prognosis （ P = 0. 039,but OR were 0. 999,95% CI contains 1 ）; TPO and MK only had lowly negative correlation （r = -0. 258 ,P = 0. 030 ） in newly-diagnosed and persistant group. Conclusion TPO may had effect on or-rcurence and development in children ITP to some extent： there existed negative modulation between TPO and MK in initial-onset ITP. Patients who had been relieved from thrombocytopenia within 12 months had low neg- ative correlation between TPO and MK, indicating TPO and MK possibiliy took part in development of ITP, while underlying pathogenesis still needed exploration.