确诊年龄与慢性免疫性血小板减少症患儿临床结局的关系研究

Relationship between the Age of Diagnosis and Clinical Outcomes in Children with Chronic Immune Thrombocytopenia

目的:探讨确诊时年龄和慢性免疫性血小板减少症(cITP)患儿临床结局的关系。方法:回顾性选择于本院就诊的cITP患儿117例,根据患儿确诊ITP时年龄将其分为2组:<10岁组和≥10岁组,对比分析两组患儿的一般资料和临床结局。Logistic回归分析确诊时年龄对cITP患儿临床结局的影响,采用受试者工作特征(ROC)曲线分析年龄对结局的预测评估价值。结果:相较于确诊年龄<10岁组,确诊时年龄≥10岁组患儿应用二线药物治疗比例(41.46%对18.42%)明显更大,≥3级出血的比例(36.59%对13.16%)明显更大,差异均有显著性统计学意义(P<0.05),但两组确诊5年后无治疗CR率差异无统计学意义(P>0.05)。Logistic回归分析结果显示,年龄(较大)是应用二线治疗、出现≥3级出血情况的不利/危险影响因素(OR>1,P<0.05)。但年龄不是确诊5年后无治疗出现CR的影响因素(P>0.05)。ROC分析结果显示,年龄对应用二线治疗与否及出现≥3级出血情况有一定的预测评估效能,AUC分别为0.741(95%CI:0.549-0.938)、0.786(95%CI:0.605-0.940),但对确诊5年后无治疗出现CR情况无预测评估价值。结论:确诊时年龄较大不利于cITP患儿预后。

Objective:To explore the relationship between age at diagnosis and clinical outcomes in children with chronic immune thrombocytopenia(cITP).Methods:A retrospective analysis was conducted on 117 children with cITP,according to the age at which the patient was diagnosed with ITP,they were divided into two groups:the<10 year old group and the≥10 year old group,the general information and clinical outcomes of the two groups of children were compared and analyzed.Logistic regression analysis was used to analyzed the impact of age at the time of diagnosis on clinical outcomes,and the predictive evaluation value of age on outcomes was assessed by the receiver operation characteristic.Results:Compared with the group with diagnosed age<10 years old,the proportion of second-line drug treatment(41.46%vs 18.42%)in the diagnosed age group≥10 years old was significantly higher,and the proportion of≥grade 3 bleeding(36.59%vs 13.16%)was significantly higher,which was significant statistical differences(P<0.05).However,there was no statistically significant difference in the proportion of untreated CR between the two groups after 5 years of diagnosis(P>0.05).Logistic regression results show that age(older)was an unfavorable/dangerous influencing factor for the occurrence of≥grade 3 bleeding after second-line treatment(OR>1,P<0.05).For the occurrence of CR after 5 years of diagnosis without treatment,age was not the influencing factor(P>0.05).ROC analysis showed that age have a certain predictive and evaluative effect on the use of second-line treatment and the occurrence of≥grade 3 bleeding,with AUC of 0.741(95%CI:0.549-0.938)and 0.786(95%CI:0.605-0.940),respectively.However,there was basically no predictive evaluation value for the occurrence of CR after 5 years of diagnosis without treatment.Conclusion:Older age at the time of diagnosis is not conducive to the prognosis of cITP patients.