初诊淋巴细胞绝对值与儿童原发性免疫性血小板减少症预后的相关性  

Relationship between initial absolute lymphocyte counts and the prognosis of children with primary immune thrombocytopenia

作　　者：吕明恩[1] 李洋[1] 刘文洁[1] 付荣凤 孙甜甜[1] 吕翠翠[1] 杨仁池[1] 

机构地区：[1]中国医学科学院北京协和医学院血液学研究所血液病医院血栓及止血中心,天津300020

出　　处：《中华实用儿科临床杂志》2015年第15期1147-1151,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81070397,81270581）;卫生行业科研专项基金（201202017）

摘　　要：目的探讨初诊淋巴细胞绝对值（ALC）预测儿童原发性免疫性血小板减少症（ITP）预后的临床应用价值。方法回顾性分析214例初诊儿童ITP患者的临床资料，并随访1年以上。通过单因素和多因素Logistic回归分析儿童ITP患者预后的影响因素，评估初诊ALC在儿童ITP预后的预测价值，与儿童ITP预后的关系，以及预后分层在临床应用价值。结果ITP患儿12个月缓解率为71．5％。多因素分析发现发病急缓、发病前6周内感染及疫苗接种史、初诊ALC和治疗疗效是儿童慢性ITP的独立影响因素（P均〈0．05）。初诊ALC 3．005×109／L是预测儿童ITP12个月内缓解的分界值，敏感度为71．9％，特异性为83．6％，ALC〉3．005×109／L组与ALC≤3．005×109／L组3个月、12个月内未缓解率差异均有统计学意义（24．2％比64．9％，8．3％比54．2％，／=42．13，P〈0．001），2组治疗后疗效比较差异无统计学意义（X2=5．098，P〉0．05），以中位年龄分组，2组间≤5岁组与〉5岁组12个月缓解率比较差异均有统计学意义（X2=22．371、22．177。P均〈0．01）。ALC与发病前6周内感染及疫苗接种史对儿童ITP预后分层，低危组、中危组、高危组3个月缓解率分别为75．8％、54．1％、22．8％，12个月缓解率分别为91．6％、68．4％、31．6％，差异均有统计学意义（X2=44．867、68．802，P均〈0．001）。结论初诊ALC是影响儿童ITP预后的独立因素，具有较好的预测价值，初诊ALC、发病前6周有无感染史及疫苗接种史对儿童1TP预后分层，可以作为临床评估儿童ITP预后的指标。Objective To investigate the value of initial absolute lymphocyte counts （ALC） in predicting the prognosis of children with primary immune thrombocytopenia（ITP）. Methods The initial clinical data of 214 children with incipient ITP were retrospectively analyzed and followed up for more than one year. Statistical analysis was made to find out the influence factors for the prognosis of patients with ITP in children to evaluate the predictive value of ALC on assessing the prognosis of ITP in children, and to analyze the association between ALC and outcomes and the clinical value of prognostic stratification. Results The remission rate of children with ITP was 71.5% in 12 months. Multiva- riate unconditioned Logistic analysis showed that disease duration, the infection history,response to treatment and ALC were independent risk factors for chronic ITP（ all P 〈0.05 ）. Cutoff value of initial ALC was 3. 005 × 109/L,sensitivity and specificity of value were 71.9% ,83.6%. Three months and 12 months no remission rate of ITP in children between ALC 〉 3. 005 × 109/L and ≤ 3. 005 × 109/L had statistical significant difference （24.2% vs 64.9%, 8.3% vs 54.2% ,X2 =42.13 ,P 〈0. 001 ）. There was no statistical difference in therapy efficacy between 2 groups（x2 = 5. 098, P 〉 0.05 ）. Remission rate between the ≤5 years old group and 〉 5 years old group was statistical difference based on age stratification （X2 = 22.371,22. 177, all P 〈 0.01 ）. ITP in children were stratified into low risk group, intermediate risk group, high risk group based on the initial ALC and infection history, with remission rates in 3 month respectively 75.8% ,54.1% ,22.8%, respectively, and 91.6% ,68.4% ,31.6% in 12 months, respectively ; there were statistically significant differences （X2 = 44. 867,68. 802, all P 〈 0. 001 ）. Conclusions Initial ALC is an independent effecting factor in the prognosis of children with ITP. Initial ALC could be used for stratifying patients with the infection history before 6 w

关 键 词：血小板减少 儿童 淋巴细胞绝对值 预后 

分 类 号：R725.5[医药卫生—儿科]