脾切除治疗免疫性血小板减少症的近远期疗效及其影响因素分析

The short-term and long-term effects of splenectomy for patients with primary immune thrombocytopenia as well as the analysis of influence factors

目的探讨ITP患者脾切除术后的近远期疗效及影响术后效果的因素。方法对2010年1月至2015年1月在郑州大学第一附属医院行脾脏切除术的56例患者进行回顾性分析,统计其术后近远期疗效。并对性别、年龄、骨髓巨核细胞数目、术前对激素反应、术前血小板数目、术后血小板峰值、病程、脾脏有无肿大、血小板抗体数目、有无副脾、手术方式进行单因素分析,对有统计学意义的影响因素采用二分类Logistic回归进行多因素分析。结果近期有效率为69.6%,远期有效率为66.1%,无死亡病例及严重并发症。单因素分析结果:年龄、术后血小板峰值、血小板抗体数目差异具有统计学意义(P<0.05)。多因素分析结果:术后血小板峰值是保护性因素(OR<1.00),年龄、血小板抗体数目是危险性因素(OR>1.00)。结论 ITP患者脾切除术后近远期疗效显著且手术安全。年龄、术后血小板峰值、血小板抗体数目可作为预测脾切除术后疗效的指标。

Objective To investigate the short - term and long - term effects as well as the influence factors of the splenecto-my for the patients with idiopathic thrombocytopenic purpura（ITP）. Methods 56 ITP patients who underwent splenectomy from January of 2010 to January of 2015 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed,and both the short - term and the long - term effects of them were used for statistic. Single factor analysis was used for the suspected influencing factors such as sex,age,the number of bone marrow megakaryocytes,preoperative response to hormones,preopera-tive platelet counts,postoperative platelet peak counts,course of disease,presence of enlarged spleen,the number of platelet an-tibody,presence of accessory spleen and surgical method. Then the Binary logistic regression was used for the multiple factors statistical analysis for those influencing factors with statistical significances. Results The short - term effective rate was 69. 6% , and the long - term effective rate was 66. 1% . There were no death cases and serious complications. Single factor analysis：age, postoperative platelet peak counts and the number of platelet antibody had statistical significances（P ﹤ 0. 05）. Multiple factors a-nalysis：the postoperative platelet peak counts was the defensive factors（OR ﹤ 1. 00）,age and the number of platelet antibody were the risk factors（OR ﹥ 1. 00）. Conclusion The operation of splenectomy for patients with ITP was considered as effective and safe with excellent both short - and long - term efficacy. Age,the postoperative platelet counts and the number of platelet antibody could be used as the predictive markers of efficacy of splenectomy.