免疫性血小板减少性紫癜患者血小板输注疗效影响因素分析  

Analysis of factors influencing curative effect of platelet transfusion in patients with immune thrombocytopenic purpura

作　　者：贺锋 李彦勋 程金凤 HE Feng;LI Yanxun;CHENG Jinfen(Department of Blood Transfusion,Zhuzhou Central Hospital,Zhuzhou,412000,China;Department of Laboratory,Zhuzhou People's Hospital,Changsha Medical College)

机构地区：[1]株洲市中心医院输血科,湖南株洲412000 [2]长沙医学院附属株洲市人民医院检验科

出　　处：《临床血液学杂志（输血与检验）》2020年第6期825-828,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：湖南省卫生健康委科研计划项目(No:20201481)。

摘　　要：目的:研究免疫性血小板减少性紫癜(ITP)患者血小板输注效果的影响因素,提高血小板输注有效率,减少血液资源浪费。方法:选取ITP患者166例,收集相关临床资料,通过单因素分析判断患者性别、病程、血小板输注次数、出血、脾肿大、糖皮质激素、丙种球蛋白使用、促红细胞生长素(TPO)应用、血小板制剂种类等是否影响血小板输注有效性。根据单因素分析结果,再进行多因素Logistic回归分析,判断血小板输注无效(PTR)的独立危险因素。结果:166例患者共输注单采血小板865人次,混合浓缩血小板1 480单位(148人次),血小板输注有效769人次,有效率75.91%,PTR 244人次,无效率24.09%。血小板输注次数、病程、脾肿大、TPO与血小板输注疗效,单因素分析χ^(2)值分别为4.364、4.828、11.516、5.376,均P<0.05。性别、出血、糖皮质激素、丙种球蛋白、血小板制剂与血小板输注疗效,单因素分析χ^(2)值分别为0.308、1.319、2.062、2.495、0.486,均P>0.05。多因素Logistic回归分析显示血,小板输注次数≥5次、病程≥1年、脾肿大、未使用TPO均为ITP患者PTR的独立危险因素,均P<0.05。结论:可根据患者血小板输注次数、病程、脾肿大、TPO使用情况对血小板输注疗效进行预判,减少PTR,对于反复出现PTR的患者可采用内科治疗手段,规避血小板输注。Objective:To study the factors that affect platelet transfusion effect in patients with immune thrombocytopenic purpura(ITP),improve the efficiency of platelet transfusion,and reduce waste of blood resources. Method:A total of 166 ITP patients were selected,and relevant clinical data were collected.The gender,course of disease,number of platelet transfusions,bleeding,splenomegaly,glucocorticoid,gamma globulin use,TPO application,type of platelet preparation were determined whether they had an effect on the effectiveness of platelet transfusion by univariate and multivariate regression analysis.According to the results of single factor analysis,multivariate logistic regression analysis was conducted to determine the independent risk factors of platelet transfusion refractory(PTR). Result:166 patients received a total of 865 apheresis platelet transfusions,1 480 units of mixed concentrated platelets(148 person-times),platelet transfusion was effective in 769 patients,the effective rate was 75.91%,PTR in 244 patients,and the inefficiency was 24.09%.Univariate analysis χ^(2)of the number of platelet transfusions,the course of disease,splenomegaly and TRO related to the curative effect were 4.364,4.828,11.516 and 5.376,respectively,which were all P<0.05.Univariate analysis χ^(2)of gender,bleeding,glucocorticoid,gamma globulin,TPO application and type of platelet preparation related to the curative effect were 0.308,1.319,2.062,2.495 and 0.486,respectively,which were all P>0.05.Multivariate Logistic regression analysis showed that the number of platelet transfusions≥5 times,course of disease≥1 year,and the unused TPO were independent risk factors for PTR in ITP patients,all P<0.05.Conclusion:The curative effect of platelet transfusion could be predicted according to the number of platelet transfusions,the course of the disease,splenomegaly and TPO usage so as to reduce the PTR.For patients with repeated PTR,medical treatment could be used to avoid platelet transfusion.

关 键 词：免疫性血小板减少性紫癜 血小板输注疗效 血小板输注无效 影响因素 

分 类 号：R457.1[医药卫生—治疗学]