原发免疫性血小板减少症患者血栓发生情况及相关危险因素分析

The incidence and risk factors for thrombosis in primary immune thrombocytopenia

目的探讨原发免疫性血小板减少症（ITP）患者血栓发生情况及相关危险因素。方法对2005年12月至2017年12月在中国医学科学院血液病医院血栓止血中心住院治疗的3 225例ITP患者进行回顾性分析。结果 共46例患者（1.43%）发生血栓事件，中位发病年龄为54（26~83）岁，成人患者中〉40岁人群血栓发生率明显高于40岁以下人群[3.37%（40/1 187）对0.58%（6/1 030），P=0.000]。男、女性患者血栓发生率差异无统计学意义[1.53%（20/1309）对1.36%（26/1 916），P=0.187]。动脉血栓的发生率高于静脉血栓[1.12%（36/3 225）对0.22%（7/3 225），P=0.000]。82.61%（38/46例）患者发生血栓时PLT〈100×109/L。吸烟、高血压病、糖尿病及脾切除是ITP患者发生血栓的危险因素（P值分别为0.232、0.531）；糖皮质激素、TPO治疗患者治疗在有无血栓事件的两组间比较差异无统计学意义（P值分别为0.064、0.075、0.531）。结论 对于中国人群，ITP疾病本身可能也是一种可伴发血栓的免疫性疾病，即使血小板水平低下仍可发生血栓事件；且具有明显的年龄分布特点；吸烟史、高血压病、糖尿病史及脾切除是发生血栓的危险因素。

Objective To probe the incidence and risk factors for thrombosis in Chinese immune thrombocytopenia through a retrospective analysis of the inpatients referred to the Blood Disease Hospital, CAMS ＆ PUMC.Methods A retrospective survey of 3 225 patients with ITP from October 2005 to December 2017 was performed, the clinical data of the patients with thrombosis were collected to analyze the causes, diagnosis, treatment and prognosis.Results A total of 46 patients experienced a thrombotic event with a prevalence of 1.43%（46/3 225 cases） with the median age of thrombosis as 54 years （26-83） years, the prevalence of thrombosis was 3.37% （40/1 187 cases） in〉40 years old, which was significantly higher than 0.58% （6/1 030 cases） in those under 40 years old, in adults （P=0.00）. There were 20 males and 26 females, there was no statistical difference in the incidence of thrombosis between males and females[1.53% （20/1 309） vs 1.36% （26/1 916）, P=0.187]; The prevalence of arterial thrombosis was 1.12% （36/3 225） higher than venous thrombosis[0.22% （7/3 225）, P=0.00]when 82.61%（38/46 cases） of patients with PLT〈100×109/L. Post-splenectomy are risk factors for thrombosis in ITP patients, P values was 0.022, There was no statistical difference in the presence or absence of thrombotic events whether received glucocorticoid or TPO/TPO-Ra treatment, the P values were 0.075 and 0.531, respectively.Conclusions In Chinese population, ITP disease maybe with a higher risk of thrombosis, there was no positive correlation between thrombosis and platelet level; and had obvious age distribution characteristics. The history of tobacco, hypertension, diabetes and post-splenectomy are risk factors for thrombosis in ITP patients.