老年原发免疫性血小板减少症患者临床特征及预后分析

Clinical characteristic and prognostic analysis of elderly primary immune thrombocytopenia

目的探讨老年原发免疫性血小板减少症(immune thrombocytopenia,ITP)患者临床特征及影响预后的相关临床因素,为老年ITP研究提供依据。方法回顾性分析2013年6月至2017年6月山西医科大学第二医院血液科收治入院的原发ITP患者,其中发病年龄≥60岁定义为老年ITP,分析患者临床表现及实验室相关检查,总结其临床特点,对于影响治疗效果及预后的危险因素进行统计学分析。结果 177例成人ITP患者中,年龄≥60岁的老年ITP有48例,平均发病年龄为(68.17±6.47)岁,男∶女性别比为1∶1,其中新诊断的ITP 30例(62.5%),持续性ITP 6例(12.5%),慢性ITP 12例(25%)。分别给予重组人促血小板生成素注射液、重组人促血小板生成素注射液联合地塞米松、静注丙种球蛋白、静注丙种球蛋白联合地塞米松、大剂量地塞米松治疗,治疗有效患者40例,有效率为83%;中位随访时间9.5个月(0.5~40.0个月),复发患者12例,复发率为30%,中位复发时间1.0个月(0.5~14.0个月)。老年ITP患者抗核抗体(antinuclear antibody,ANA)阳性率(54.2%)明显高于非老年患者(23.3%)(P<0.05),出血评分≥2分者比例占77.1%明显高于非老年组(出血评分≥2分者占49.6%)(P<0.05)。预后方面显示自然杀伤(natural killer,NK)细胞比例减低为影响疾病复发的危险因素(P<0.05)。结论老年ITP患者出血评分更高,且更易合并高血压、糖尿病等基础疾病,应早期积极预防脑出血、重要脏器出血等合并症的发生。老年ITP更易合并ANA抗体阳性,提示应注意排查继发结缔组织病及其他潜在恶性疾病可能。NK细胞比例减低为疾病复发的危险因素,对于其作用机制有待于进一步研究。

Objective To explore the clinical features and prognostic factors of elderly-onset primary immune thrombocytopenia(ITP)and provide more evidence for the treatment of it.Methods Totally 177 cases of ITP were selected from the Second Hospital of Shanxi Medical University hospitalized patients(2013.06.01-2017.06.01)to summarize the clinical-data,including clinical manifestation,laboratory findings,treatment,therapeutic effect,prognosis of scheme.ITP of patients older than 60 years were defined as elderly-onset ITP.Results The data were collected from 177 ITP cases,and 48 of those were elderly-onset ITP.The ratio of male to female was 1∶1,with an average age of(68.17±6.47)years.There were 30(62.5%)cases of newly diagnosed ITP,6(12.5%)cases of persistent ITP and 12(25%)cases of chronic ITP.After the treatment of rhTPO,rhTPO combined with dexamethasone,IVIG,IVIG combined with dexamethasone or high dose-dexamethasone,40 patients got remission and the overall remission rate was 83%.The ANA was positive in 54.2%of elderly-onset ITPs,which was significantly higher than that in the no-elderly-onset ITP group(P<0.05);The proportion of cases with bleeding score above two was 77.1%in elderly-onset ITPs,which was significantly higher than that in the no-elderly-onset ITP group(P<0.05).With a median follow-up of 9.5 monthes(range from 0.5 to 40.0 monthes),there were 12 patients who finally replased.The replase rate was 30%and the median replase time was one month(range 0.5 to14 monthes).The lower percentage of NK cell was the risk factor for replase(P<0.05).Conclusion Elderly-onset ITP has higher bleeding scores and more underlying diseases such hypertensions and diabetes mellitus.Therefore,these patients need more attention in clinical practice and treatment for preventing complication should be started actively.Elderly-onset ITP was more likely to have positive ANA,suggesting that connective tissue diseases need to be excluded before making the diagnosis of ITP.The lower percentage of NK cell was the risk factor for replase in elderly-onset ITP,and further studies are needed to explore the underlying mechanism.