免疫性血小板减少症合并心肌损伤患儿临床分析

Analysis of clinical characteristics of immune thrombocytopenia children with myocardial injury

目的探讨合并心肌损伤的免疫性血小板减少症(ITP)患儿的临床特点。方法回顾分析2018年12月至2020年4月收治的新诊断ITP患儿的临床资料,根据是否合并心肌损伤将患儿分为非心肌损伤组和心肌损伤组,并分析两组的临床特点、实验室检查以及转归情况。结果新诊断ITP患儿360例,男240例、女120例,中位年龄3.0(2.0~6.0)岁,其中非心肌损伤组294例,心肌损伤组66例。与非心肌损伤组相比,心肌损伤组患儿肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶-L明显升高,女性比例偏高,年龄偏低,血小板计数(PLT)较高,血栓弹力图最大振幅较大,PLT<10×10^(9)/L以及出血评分>3分比例较低,白细胞、淋巴细胞、CD8^(+)T淋巴细胞以及NK细胞计数均显著升高,IgE水平偏低,差异均有统计学意义(P<0.05)。Log-rank检验提示非心肌损伤组PLT升至≥30×10^(9)/L时就诊天数短于心肌损伤组,差异有统计学意义(P<0.001)。结论ITP患儿合并心肌损伤并非少见,且PLT恢复速度慢,但合并心肌损伤并未促进新确诊的ITP患儿进展为持续性ITP。

Objective To investigate the clinical characteristics of immune thrombocytopenia(ITP)children with myocardial injury.Methods Newly diagnosed ITP children hospitalized in Wuhan Children's Hospital from December 2018 to April 2020 were retrospectively analyzed.According to the complication,children were divided into the non-myocardial injury group and myocardial injury group.The clinical characteristics,laboratory examination and prognosis of the two groups were compared.Results In this study,360 newly diagnosed ITP children were analyzed,including 240 boys and 120 girls,with a median age of 3.0(2.0~6.0)years.Of the 360 children,294 were in the non-myocardial injury group and 66 were in myocardial injury group.Compared with the non-myocardial injury group,levels of CK,CK-MB and LDH-L in myocardial injury group were higher,the proportions of girls and younger children were higher,the values of thromboelastogram-maximal amplitude were larger,the proportions of children with PLT<10×10^(9)/L/bleeding score>3 were lower,the counts of platelet,white blood cells,CD8^(+)T cells and NK cells were higher,the levels of IgE were lower.These differences were statistically significant(P<0.05).Log-rank analysis showed that platelet recovery of the myocardial injury group was slower than the non-myocardial injury group after treatment(P<0.001).Conclusion It is not rare for ITP children with myocardial injury.Although platelet recovery is slower at initial diagnosis,myocardial injury does not promote the progression of newly diagnosed ITP to persistent ITP.