两种原发免疫性血小板减少症出血评分系统的对比研究

Comparative study between two bleeding grading systems of primary immune thrombocytopenia

目的前瞻性评价中华医学会血液学分会在《成人原发免疫性血小板减少症诊断与治疗中国专家共识（2016年版）》中推荐的原发免疫性血小板减少症（ITP）出血评分量表（2016版ITP出血评分量表）的临床应用价值。方法采用2016版ITP出血评分量表和ITP特异性出血评价工具（ITP-BAT）对88例ITP患者进行出血评分，分析血小板计数、性别、疾病分期与2016版ITP出血评分量表评分的关系和两种出血评分系统的一致性。在47例新诊断ITP患者大剂量地塞米松治疗前及治疗后1、2周分别进行2016版ITP出血评分量表评分及血小板计数检查，评估2016版ITP出血评分量表的反应度。结果出血评分和患者血小板计数呈负相关（r=-0.515，P〈0.001），不同性别、疾病分期患者2016版ITP出血评分量表评分差异无统计学意义（F=4.255，P=0.382；F=5.251，P=0.753）。ITP出血评分量表与ITP-BAT具有很好的一致性。47例ITP患者大剂量地塞米松治疗前后出血评分比较差异具有统计学意义（z=-5.612，P〈0.001），治疗后未达到完全反应的患者治疗前后出血评分比较差异具有统计学意义（z=-3.969，P〈0.001）。两名医师背靠背评分完全相同的比例为94.4%（k=0.918）。应用2016版ITP出血评分量表进行评分耗时短于ITP-BAT评分系统[3（2-6）min对7（4-13）min，z=-8.213，P〈0.001]。结论2016版ITP出血评分量表在临床应用中具有很好的反应度及评价一致性，与ITP-BAT评分系统具有很好的一致性，且采集信息耗时短，可作为病情判断、风险评估及疗效评价的有效工具。

ObjectiveTo evaluate prospectively the clinical significance of immune thrombocytopenia （ITP） bleeding scale （version 2016 of ITP bleeding scale） recommended in consensus of Chinese experts on diagnosis and treatment of adult primary immune thrombocytopenia （version 2016） by Chinese Medical Association.MethodsA total of 88 patients were assessed by ITP bleeding scale （version 2016） and ITP specific bleeding assessment tool （ITP-BAT） to analyze the association between bleeding score of ITP bleeding scale （version 2016） and platelet counts, gender, disease stage, also to evaluate interinstrument consistency between two bleeding grading systems. Among 47 newly diagnosed ITP patients treated with high dose dexamethasone, bleeding score of ITP bleeding scale （version 2016） and platelet counts were assessed before treatment, one week and two weeks after treatment, respectively, and the responsiveness of ITP bleeding scale （version 2016） was evaluated.ResultsBleeding score of ITP patients was negatively correlated with platelet counts （r=-0.515, P〈0.001） . Gender and disease stage had no significant influence on bleeding score （F=4.255, P=0.382; F=5.251, P=0.753） . ITP bleeding scale was in excellent agreement with ITP-BAT. Change of bleeding score of 47 ITP patients before and after high dose dexamethasone treatment had significant difference （z=-5.612, P〈0.001） , also, the same result was observed in patients who didn＇t get complete response （z=-3.969, P〈0.001） . Back-to-back scoring consistency of two doctors was 94.4% （k=0.918） . It took less time to accomplish ITP bleeding scale （version 2016） than that of ITP-BAT [3 （2-6） min vs 7 （4-13） min, z=-8.213, P〈0.001].ConclusionITP bleeding scale （version 2016） has good responsiveness, strong assessment consistency, close correlation with ITP-BAT and less time-consuming in clinical application. It can be used as an effective tool of condition judgement, risk assessment and efficacy evaluation of ITP patients.