儿童免疫性血小板减少症360例临床特征分析

Analysis of cinical characteristics in 360 children with immune thrombocytopenia

目的按目前国内外免疫性血小板减少症(ITP)诊疗建议分析ITP患儿各型临床特征。方法回顾性分析本院2008年1月1日-2013年12月30日住院治疗的360例资料完整并有随访记录的ITP患儿临床资料,统计各型临床特征等相关数据。结果 (1)360例ITP患儿中新诊断ITP、持续性ITP及慢性ITP分别占60.8%、26.9%、12.3%,男女比例为1.6∶1,各型男女比例无显著性差异(P>0.05);发病年龄以婴幼儿为主,慢性型以学龄儿为主(56.8%),各型年龄分布有显著性差异(P<0.05);发病季节春夏为主,各型无显著性差异(P>0.05)。(2)各型有诱因者分别为64.5%、53.6%、34.1%,慢性ITP诱因不明显(P<0.05);各型初诊病程分别为(11.49±7.50)d、(41.55±10.55)d、(402.83±28.26)d,慢性ITP病程较其他两型长(P<0.05);各型出血以轻度为主,重度出血有差异(P<0.05)。结论 (1)儿童ITP新诊断型多见,慢性型少见;发病年龄婴幼儿为主,慢性ITP以年长儿为主;多数患儿起病前有诱因,尤其新诊断ITP及持续性ITP。(2)各型ITP患儿临床以轻度出血为主,重度出血少见,但慢性ITP重度出血明显。

Objective To analyze the clinical characteristics of all types of ITP according to the latest treatment recommendations. Methods The clinical data of 360 children with ITP from our hospital between January 1, 2008 to December 30, 2013 was retrospectively analyzed. Results ①Among the 360 ITP children, newly diagnosed ITP, persistent ITP and chronic ITP accounted for 60.8%, 26.9% and 12.3 % respectively. The ratio of male to female was 1.6 ： 1. The sex ratio showed no significant difference in these three groups （P 〉 0.05）. The cases were mainly infants, while most of chronic ITP were schoolage children. And there was significant difference in the age distribution （ P 〈 0.05 ）. The peak seasons were summer and autumn, but there was no significant difference （P 〉 0. 05）. ②The proportion of incentives in all types was 64. 5%, 53.6% and 34. 1%, but the chronic group didn＇ t have the obvious incentive （P 〈 0.05）. The mean course of disease were （ 11.49 ±7.50）, （41.55 ±10.55 ） and （402.83 ±28.26） days in the three types. The course of chronic ITP was longer than the other two types （P 〈 0. 05）. Mild bleeding accounted mostly, and there was significant difference in the severe bleeding among the three types （ P 〈 0. 05 ）. Conclusions ①Newly diagnosed ITP was the most common type in pediatric ITP, while the chronic type was rare. The main onset age was in infancy, but the chronic ITP was in elder children. Most patients had a certain incentive, especially in newly diagnosed ITP and persistent ITP. ②No or mild bleeding were common, and severe bleeding in ITP patients was rare. However the chronic ITP patients had an obvious trend of bleeding.