老年原发免疫性血小板减少症患者115例临床分析

Retrospective analysis of 115 cases of elderly immune thrombocytopenia

目的分析老年原发免疫性血小板减少症(ITP)患者的临床特征、治疗疗效及预后。方法回顾性分析2013年1月—2017年10月在绍兴市人民医院血液内科住院的115例60岁以上老年ITP病例资料,记录所有ITP患者的临床特点,包括出血评分、治疗方法、治疗疗效、骨髓象、Th1/Th2细胞因子表达、继发感染与其他并发症,以及预后情况。采用SPSS 17.0统计软件分析。结果 115例60岁以上老年ITP患者中,男性52例,女性63例。年龄60～91岁,中位年龄67岁。年龄增大,出血患者的比例增加,其中中度及严重出血患者比例亦增加。老年ITP患者中存在Th1/Th2免疫平衡紊乱,IFN-γ、IL-10显著降低,其他指标如TNF-α、IL-2、IL-4、IL-5显著升高(P<0.05)。随着年龄增大和病程时间延长,老年ITP患者的治疗有效率降低,60～69岁组的治疗有效率最高(86.9%)。老年ITP患者在使用肾上腺糖皮质激素期间易继发感染(22.1%),多为肺部真菌感染。115例老年ITP患者,死亡6例,占5.2%;其中4例死于肺部感染,1例死于颅内出血,1例死于心源性猝死。结论老年ITP患者随年龄增大及病程延长,出血风险增加及治疗疗效降低,存在Th1/Th2免疫平衡紊乱;老年ITP的肾上腺糖皮质激素治疗易继发感染及成为致死原因,临床治疗需权衡利弊。

Objective To analyze the clinical characteristics, therapeutic effect and prognosis of primary immune thrombocytopenia(ITP) in the elderly. Methods The clinical data of 115 elderly patients with ITP hospitalized in our department of hematology from January 2013 to October 2017 were retrospectively analyzed, who were over 60 years old. The clinical characteristics of all patients with ITP were recorded, including bleeding score, treatment method and treatment effect. Bone marrow image and Th1/Th2 cytokine expression, secondary infection and other complications as well as prognosis. Statistical analysis were conducted by SPSS 17.0. Results There were 52 males and 63 females in 115 elderly patients over 60 years with ITP. The median age was 67 years old, ranging from 60 to 91. Of 115 elderly ITP patients, with the increase in age, the higher would be the risk of bleeding, and so did the proportion of severe bleeding patients. In elderly patients with ITP, IFN-γ and IL-10 were significantly decreased, and other indicators such as TNF-α, IL-2, IL-4 and IL-5 were significantly increased(P<0.05). The therapeutic effects were decreased with increased age or delayed course. The treatment effective rate of 60-69 years old group was the highest(86.9%). The elderly ITP patients easily suffered from infections during the use of glucocorticoid(22.1%), and the most common was pulmonary fungus infection. Six patients died(5.2%): four died of pulmonary infection, only one of intracranial hemorrhage. Conclusion Elderly ITP patients were more severe. With increasing age and duration of the disease, the patient’s treatment efficiency is lower. There is disturbance of immune balance of Th1/Th2 in elderly ITP patients. Patients have a higher incidence of infections and becomes the cause of death during the use of glucocorticoids. The choice of treatment needs to balance advantages and disadvantages.