影响儿童原发性免疫性血小板减少症临床预后因素的研究

Study on the clinical prognostic factors of primary immune thrombocytopenia in children

目的探讨影响儿童原发性免疫性血小板减少症(ITP)患儿预后的临床指标,重点评价初诊淋巴细胞绝对值(ALC)的临床意义。方法回顾性分析广东省珠海市妇幼保健院2013—2019年收治的236例ITP患儿临床资料,将10项临床指标与预后做统计学分析,着重研究初诊ALC与预后的关系。结果单因素分析发现年龄、发病前有感染及预防接种史、初诊ALC、治疗方式及治疗后疗效与预后相关,性别、季节、出血情况、初诊WBC和血小板计数与预后无相关性。多因素分析示儿童慢性ITP的独立影响因素为发病前有诱因和初诊ALC。受试者工作特征曲线(ROC)显示初诊ALC为3.850×10^(9)/L是预测儿童ITP持续性和慢性的分界值,按ALC>3.850×10^(9)/L和ALC≤3.850×10^(9)/L比较各年龄组患儿12个月内缓解率,差异有显著性。结论初诊ALC是儿童ITP预后的独立影响因素,在不同年龄段均可作为评判ITP预后的一项指标。

Objective To explore the clinical indicators affecting the prognosis of children with primary immune thrombocytopenia(ITP),and to evaluate the clinical significance of absolute lymphocytes(ALC)at first diagnosis.Methods Clinical data of 236 children with ITP admitted to the Zhuhai Center for Maternal and Child Care of Guangdong from 2013 to 2019 were analyzed retrospectively.The 10 clinical indicators and prognosis were statistically analyzed,and the relationship between ALC at first diagnosis and prognosis was emphatically studied.Results Univariate analysis revealed that age,history of infection and vaccination before the onset,ALC at first diagnosis,treatment methods and post-treatment efficacy were related to prognosis while gender,season,bleeding status,white blood cell and platelet count at first diagnosis had no correlation with prognosis.Multivariate analysis showed that the history of infection and vaccination before the onset and the ALC at first diagnosis were independent influencing factors of chronic ITP in children.The receiver operating characteristic curve showed that the ALC of 3.850×10^(9)/L at first diagnosis was the cut-off value for predicting the persistence or chronicity of ITP in children.According to ALC>3.850×10^(9)/L and ALC≤3.850×10^(9)/L,the difference of remission rate within 12 months of each age group was statistically significant.Conclusions ALC at first diagnosis is an independent influencing factor of children′s ITP.It can be used as index to evaluate the prognosis of ITP in different age groups.