儿童慢性特发性血小板减少性紫癜的诊治和预后  

Diagnosis,Treatment and Prognosis in Children with Idiopathic Thrombocytopenic Purpura

作　　者：余佳宁[1] 马立燕[1] 郑漪[1] 郑传经[1] 

机构地区：[1]宁夏医学院附属医院儿科,银川750004

出　　处：《宁夏医学院学报》2008年第1期37-39,56,共4页Journal of Ningxia Medical College

摘　　要：目的探讨儿童慢性特发性血小板减少性紫癜（CITP）的诊断、治疗和预后。方法分析我院1980～2005年收住并有随访结果的CITP 115例的诊断、治疗及2～25年随访资料。结果115例中自发缓解17例，药物治疗有效72例，脾切除有效13例，难治性儿童特发性血小板减少性紫癜（ITP）5例，轻度至中度血小板减少3例。死亡5例，3例为颅内出血，1例为脾切除后仍出血，1例为激素治疗中患爆发性水痘。结论儿童CITP经过多年甚至10余年后仍有可能恢复。诊断应根据外周血检查是否典型和病情进展，有选择地做骨髓细胞学检查。CITP可能是某些自身免疫性疾病的早期表现，应长期随访观察。Objective To Explore the diagnosis, various methods of treatment and the prognosis in children with idiopathic thrombocytopenic purpura（ITP）. Methods Diagnosis was confirmed by history, physical examination, complete blood coum with examination of the peripheral blood smear and bone marrow smear. Treatment was based on glucocorticoid and if the first treatment was no effect, the second line drugs were added. If bleeding remained severe still, splenectomy would be done. 115 CITP children were followd up 2 - 25 years and the remainnig ITP cases admitted at the same time were reviewed. Results Of 665 ITP patients were admitted from 1980.1 to 2005.12, acute ITP（AITP）were 526（79.1% ）, CITP 139（20.9% ）. Of 115 CITP, five patients （4.3%）diedof CITP. Of these 5 dead, three had intmcranial hemorrhage, one died of hemorrhage after splenectomy, and another one died of fulminant varicella during prednisone treatment for two months. Conclusion The prognosis of ITP in childhood is good. The majority of them are self-limited disease, and can be spontaneously recovered. Bone marrow examination should be done selectively and individually. If the peripheral blood examination are typical of that of ITP, bone marrow examination could be omitted. If atypical,and ITP not remitted after 3-6 weeks, bone marrow examination should be done to rule out other hemopoietic diseases. CITP may be the early manifestations of some other autoimmune diseases, so it should be followed-up over a long time. The goal of treating ITP is to decrease or to stop the bleeding, so according to the severity of bleeding, we accept stratigies that combined megadose of glucocorticoid, IVIG, platelet transfusion therapy. Though the severity of bleeding may not be parallel with the quantity of thrombocytes, in severe bleeders the platelets are always severely decreased. So the level of platelet count may be an important imformation for treatment. Administrate glucocorticoid for a long time or indulge in use of Ig are inappropriate too. Their a

关 键 词：儿童 慢性特发性血小板减少性紫癜 诊断 治疗 预后 

分 类 号：R725.5[医药卫生—儿科]