儿童免疫性血小板减少症预后相关因素

Prognostic factors in immune thrombocytopenia in children

目的探讨初诊外周血淋巴细胞绝对值(ALC)与儿童原发性免疫性血小板减少症(ITP)预后的关系,为临床判断儿童ITP预后及治疗提供依据。方法回顾性分析贵州医科大学附属医院2014年1月至2018年3月收治的166例ITP患儿的临床资料,并采用门诊及电话随访的方式对与儿童ITP预后有关的因素(性别、年龄、民族、诱因、出血情况、初诊时ALC、血小板计数及治疗方式)进行统计学分析,观察外周血ALC与儿童ITP预后的关系。结果166例ITP患儿中,89例(53.6%)3个月内缓解,18例(10.8%)3~12个月缓解,20例(12.0%)1~4年缓解,39例(23.5%)1~10年未缓解,1年内缓解率为64.5%,总缓解率为76.4%。3个月内、3~12个月、1~4年缓解患儿中ALC分别为(4.58±2.87)×10^9/L、(4.47±2.04)×10^9/L和(2.86±1.61)×10^9/L,共有39例(23.5%)属于难治病例(1~10年未缓解),其ALC为(2.07±0.98)×10^9/L,组间比较差异有统计学意义(F=12.06,P<0.01)。单因素分析显示年龄(F=27.28)、发病前有感染史及预防接种史(χ^2=9.31)、初诊时ALC(F=12.06)与患儿预后相关(均P<0.05)。多因素分析显示发病前有感染史及预防接种史(95%CI:0.19~1.51,P<0.05)、初诊时ALC(95%CI:-0.64^-0.23,P<0.001)是影响患儿预后的独立影响因素。以是否发展为慢性(病程>12个月)为状态变量、ALC为检验变量绘制受试者工作特征曲线(ROC)选择最佳的界限值,曲线下面积(AUC)为0.765(P<0.05),截点值为3.925×10^9/L,敏感度为0.542,特异度为0.966。结论初诊时ALC可作为儿童ITP评估预后指标之一,低ALC是儿童ITP慢性发展的危险信号。

Objective To explore the prognostic relationship between initial absolute lymphocyte count(ALC) of peripheral blood and primary immune thrombocytopenia (ITP) in children, in order to provide basis for judging the prognosis and treatment of ITP in children. MethodsClinical data of 166 children with primary ITP in children admi-tted at the Affiliated Hospital of Guizhou Medical University from January 2014 to March 2018 were analyzed retrospectively, and they were followed up by clinic and telephone, the prognostic factors (gender, age, ethnicity, inducement, bleeding, initial ALC, platelet count and treatment) were statistically analyzed, and the relationship between ALC of peripheral blood and the prognosis of children with ITP was observed. ResultsOf 166 children with ITP, 89 cases (53.6%) had remission within 3 months, 18 cases (10.8%) within 3-12 months, 20 cases (12.0%) within 1-4 years, a total of 39 cases (23.5%) were refractory (no remission in 1-10 years), the remission rate within 1 year was 64.5%, the total remission rate was 76.4%.ALC of remission cases was (4.58±2.87)×10^9/L within 3 months,(4.47±2.04)×10^9/L within 3-12 months, and (2.86±1.61)×10^9/L within 1- 4 years.Thirty-nine cases (23.5%) were refractory(no remission in 1-10 years), ALC of them was (2.07±0.98)×10^9/L, and there were significant differences among different groups (F= 12.06, P<0.01). Univariate analysis showed that age (F=27.28), pre-morbidity history of infection and vaccination history(χ^2= 9.31), initial ALC (F=12.06) at initial diagnosis were related with the prognosis of children with ITP (all P<0.05). Multivariate analysis showed that the history of infection before onset, the history of vaccination(95%CI: 0.19 to 1.51, P<0.05)and initial ALC(95%CI:-0.64 to -0.23, P<0.001) at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP.The receivers operating characteristic (ROC) was drawn with the development of chronic disease (course >12 months) as state variable and ALC as test variable.The area under curve(AUC) was 0.765(P<0.05), cut-off point was 3.925×10^9/L, sensitivity was 0.542, and specificity was 0.966. ConclusionsInitial ALC can be used as one of the prognosis index of ITP in children, and low ALC is the risk signal for chronic development of ITP in children.