儿童原发性免疫性血小板减少症预后因素的研究

Prognostic factors of primary immune thrombocytopenia in children

目的探索影响儿童原发性免疫性血小板减少症(ITP)预后的因素。方法选择2017年1月至2021年3月在揭阳市人民医院儿科住院的123例ITP患儿进行回顾性研究,收集其临床资料,根据病情分为慢性ITP(CITP)组(20例)与非慢性ITP(NCITP)组(103例)。CITP组男14例,女6例,<3岁7例,≥3岁13例;NCITP组男61例,女42例,<3岁74例,≥3岁29例。分析比较两组患儿的人口学资料、初诊时血小板计数、淋巴细胞绝对值(ALC)、出血评分、初始治疗情况、治疗后血小板峰值及治疗前和治疗后淋巴细胞亚群结果,通过单因素分析影响ITP患儿预后的相关因素。统计学方法采用χ2检验、t检验、非参数U检验。结果两组初诊时血小板计数比较,差异有统计学意义(Z=-3.45,P<0.05)。治疗后血小板峰值比较,差异有统计学意义(Z=-2.85,P<0.05)。治疗后,CITP组的辅助性T细胞(Th)百分比明显低于NCITP组[(30.52±5.66)%比(35.82±9.08)%],差异有统计学意义(t=2.51,P<0.05);初诊时CITP组ALC低于NCITP组[(2.17±1.03)×109/L比(4.68±2.45)×109/L],差异有统计学意义(t=15.07,P<0.05)。采取对症+免疫球蛋白(IVIG)治疗的ITP患儿中CITP占比8%(8/100),低于单纯采取对症治疗[52.9%(9/17)]和采取对症+IVIG+糖皮质激素治疗[50.0%(3/6)],差异均有统计学意义(均P<0.05)。治疗后CITP组的Th百分比明显低于NCITP组[(30.52±5.66)%比(35.82±9.08)%],差异有统计学意义(t=2.51,P<0.05)。结论年龄≥3岁、初诊时血小板计数偏高及低ALC、治疗后血小板峰值偏低和Th百分比偏低可能是ITP慢性化的危险因素,IVIG治疗对ITP的预后有良好意义。

Objective To investigate the prognostic factors of primary immune thrombocytopenia(ITP)in children.Methods One hundred and twenty-three children with ITP hospitalized in Department of Pediatrics,Jieyang People's Hospital from January 2017 to March 2021 were selected for the retrospective analysis.Their clinical data were collected.According to their conditions,they were divided into a chronic ITP(CITP)group(20 cases)and a non-chronic ITP(NCITP)group(103 cases).There were 14 boys,6 girls,7 cases who were<3 years old,and 13 cases who were≥3 years old in the CITP group.There were 61 boys,42 girls,74 cases who were<3 years old,and 29 cases who were≥3 years old in the NCITP group.The demographic data,platelet counts at first diagnosis,initial absolute lymphocyte counts(ALC),bleeding scores,initial treatment,platelet peak values after treatment,and lymphocyte subsets before and after the treatment were analyzed and compared between the two groups.The related factors affecting their prognosis were analyzed by univariate analysis.χ2 test,t test,and nonparametric U test were applied.Results There was no statistical difference in the platelet count at first diagnosis between the two groups(Z=-3.45,P<0.05).There was a statistical difference in the platelet count after the treatment between the two groups(Z=-2.85,P<0.05).The percentage of Th cells after the treatment in the CITP group were obviously lower than that in the NCITP group[(30.52±5.66)%vs.(35.82±9.08)%],with a statistical difference(t=2.51,P<0.05).When they were first diagnosed,the ALC in the CITP group was lower than that in the NCITP group[(2.17±1.03)×109/L vs.(4.68±2.45)×109/L],with a statistical difference(t=15.07,P<0.05).Eight percent(8/100)of the children with ITP who took symptomatic treatment and immunoglobulin(IVIG)had CITP,52.9%(9/17)of the children with ITP who took symptomatic treatment only,and 50.0%(3/6)of the children with ITP who took symptomatic treatment,IVIG,and glucocorticoid,with statistical differences(both P<0.05).After the treatment,the percentage of helper T cells in the CITP group was obviously lower than that in the NCITP group[(30.52±5.66)%vs.(35.82±9.08)%],with a statistical difference(t=2.51,P<0.05).Conclusions≥3 years old,high platelet count and low ALC at first diagnosis,and low platelet peak and low Th cell percentage after treatment may be the risk factors for chronic ITP.IVIG treatment has good significance for the prognosis of children with ITP.