ITP-BAT出血评分系统在原发免疫性血小板减少症的临床应用价值

Clinical significance of ITP-BAT bleeding grading system for patients with immune thrombocytopenia

目的 研究ITP-BAT出血评分系统在原发免疫性血小板减少症（ITP）的临床应用价值.方法 采用ITP-BAT出血评分系统对183例ITP患者进行出血评分及出血严重程度分级,分析ITP患者出血评分与血小板计数、年龄、性别、疾病分期的关系以及ITP-BAT出血评分系统的反应度、重测可信度.结果 ITP患者出血程度与血小板计数呈负相关（r=-0.744,P＜0.01）,PLT≤20×109/L时,患者出血程度加重（χ^2=82.40,P＜0.01）.儿童患者轻度出血占68.4％（26/38）,与其他年龄组比较差异有统计学意义（χ^2=8.839,P＜0.01）.年龄≥60岁老年患者严重出血占老年患者14.3％（3/21）,与其他年龄组比较差异有统计学意义（χ^2=7.056,P＜0.01）.性别和疾病分期在出血程度上差异无统计学意义（χ^2=4.922,P＞0.05;χ^2=3.411,P＞0.05）.ITP患者治疗前后出血评分差异具有统计学意义（Z=-6.61,P＜0.01）.两名医师评分结果完全相同的比例为66.1％（κ=0.561）,同一名医师两次评分结果完全相同的比例为94.7％（κ=0.874）.结论 ITP-BAT出血评分系统在中国ITP患者中有很好的效度和反应度,与临床指标密切相关,能敏感地反映患者出血症状的变化,可以作为治疗的参考指标和疗效的观察指标.

Objective To explore the clinical significance,reliability and responsiveness of ITP-BAT bleeding grading system for patients with immune thrombocytopenia（ITP）.Methods One hundred and eighty-three patients with ITP were assessed by using of ITP-BAT bleeding grading system.Test-retest reliability,responsiveness of ITP-BAT bleeding grading system and association between bleeding grades and platelet counts,age,gender,disease stage were analyzed.Results Bleeding degree of ITP patients and the platelet count were negatively correlated （r=-0.744,P〈0.01） and bleeding degree increased significantly with platelet counts below 20 × 109/L （χ^2=82.40,P〈0.01）.Mild bleeding rate in children was 68.5%,higher than that in adult （χ^2=8.839,P〈0.01）,and severe bleeding rate in the elderly was 14.3%,higher than that in non-elderly （χ^2=7.056,P〈0.01）.There were no significant differences in bleeding degree in patients with different gender and disease stage （χ^2=4.922,P〉0.05 and χ^2=3.411,P〉0.05）.Bleeding grades before and after treatment had more significant difference （Z=-6.61,P〈0.01）.Scoring consistency of two doctors was 66.1% （κ=0.561）,and scoring consistency of the same doctor was 94.7% （κ=0.874）.Conclusions ITP-BAT bleeding grading system in China has good validity and responsiveness,closely related to clinical indicators.It is sensitive to the variation of the hemorrhage in patients.ITP-BAT could be used as a reference index of the treatment,and also be used as an observation index of curative effect.