儿童免疫性血小板减少症预后影响因素的评分研究

Research on rating of prognostic factors in children immune thrombocytopenia

目的分析影响儿童免疫性血小板减少症预后的相关因素,并建立关于儿童免疫性血小板减少症患儿预后的临床评分系统。方法(1)对本院2016年3月至2019年2月期间治疗的206例儿童免疫性血小板减少症患儿进行资料统计,分别记录性别、年龄、初诊时血小板数目、出血及感染情况、治疗效果,并对其中103例进行骨髓穿刺检测患儿骨髓中巨核细胞数目;(2)对患儿进行门诊及电话随访;(3)对预后影响因素进行单因素分析及多因素Logistic回归分析;(4)赋予危险因素合理的分值,计算评分高低与预后的关系。结果随访的206例儿童免疫性血小板减少症的患儿,170例预后良好,36例预后不良;其中103例行骨髓穿刺检查的患儿中,76例预后良好,27例预后不良;统计学分析结果显示两组患儿在年龄、前驱感染、有无出血、初诊时血小板数目及巨核细胞数目方面,差异有统计学意义,在性别、治疗方案方面,差异无统计学意义。在多因素Logistic回归分析中,影响预后的独立因素为年龄、有无出血、前驱感染、初诊时血小板数目及巨核细胞数目;对以上各因素进行赋分,并计算总得分,结果显示得分越低,预后越好。结论年龄、有无出血、前驱感染、初诊时血小板数目及巨核细胞数目对儿童免疫性血小板减少症的预后有重要的预测意义,可用于指导治疗。

Objective To investigate the factors affecting the prognosis of children immune thrombocytopenia,and to establish a clinical scoring system for the prognosis of children immune thrombocytopenia.Methods(1)Data of 206 children with immune thrombocytopenic treated in our hospital from March 2016 to February 2019 were statistically analyzed.Gender,age,i-nitial platelet count,bleeding,infection,and therapeutic effect were recorded,respectively.Moreover,the number of megakaryocytes of 103 children who underwent bone marrow biopsy were recorded.(2)Outpatient and telephone follow-up were conducted for the children.(3)To make univariate and multivariate Logistic regression analysis on the prognostic factors.(4)To assign reasonable scores to risk factors and to calculate the relationship between score and prognosis.Results Among 206 cases with immune thrombocytopenic,170 cases had a good prognosis and 36 had a poor prognosis;among the 103 cases who underwent bone marrow biopsy,76 cases had good prognosis and 27 cases had poor prognosis.The results of statistical analysis showed that there were statistically significant differences in age,prodromal infection,bleeding,initial platelet count and initial Megakaryocyte count,without statistically significant differences in gender or treatment.In the multivariate Logistic regression analysis,the independent risk factors affecting prognosis were age,bleeding,prodromal infection,initial platelet count and initial Megakaryocyte count.The above factors were assigned and the total score was calculated.The results showed that the lower the score was,the better the prognosis was.Conclusion Age,bleeding,prodromal infection,initial platelet count and initial Megakaryocyte count have important predictive significance for the prognosis of immune thrombocytopenia and can be used to guide the treatment.