儿童原发性免疫性血小板减少症回顾性临床分析  

Retrospective clinical analysis of primary immune thrombocytopenia in children

作　　者：王兆辉[1] 王绪栋[1] 罗荣华[1] 孙燕 常光妮 孙俊霞 刘亚蒙 高婷婷 WANG Zhaohui;WANG Xudong;LUO Ronghua;SUN Yan;CHANG Guangni;SUN Junxia;LIU Yameng;GAO Tingting(Department of Pediatric Hematology,Shandong Taian Central Hospital,Taian Central Hospital Affiliated to Qingdao University,Taishan Medical Care Center,Shandong,Taian 271000,China)

机构地区：[1]山东省泰安市中心医院,青岛大学附属泰安市中心医院,泰山医养中心儿童血液科,山东泰安271000

出　　处：《中国医药科学》2024年第16期76-79,共4页China Medicine And Pharmacy

基　　金：山东省泰安市科技创新发展项目(2022NS265)

摘　　要：目的提高对儿童原发性免疫性血小板减少症(ITP)临床特点及预后的再认识,为儿童ITP诊疗提供依据。方法回顾性分析泰安市中心医院2019年10月至2021年6月收治的150例初诊为ITP的患儿,并随访至发病后6个月。根据血小板计数分为两组:非重型ITP为单用糖皮质激素(GCs)组,重型ITP为GCs联合静脉注射免疫球蛋白(IVIG)组。对年龄、性别、初诊血小板膜蛋白特异性抗体、初诊骨髓巨核细胞数目、治疗反应、预后等数据进行分析。结果150例初诊ITP患儿发病年龄为[4.50(0.25,13.00)]岁,其中男82例(54.67%),女68例(45.33%)。血小板膜蛋白特异性抗GPⅠb抗体阳性32例(21.33%),抗GPⅨ抗体阳性15例(10.00%),抗GPⅡb抗体阳性86例(57.33%),抗GPⅢa抗体阳性76例(50.67%),抗GMP-140抗体阳性23例(15.33%),血小板膜蛋白特异性抗体阴性42例(28.00%);完全反应(CR)+反应(R)组初诊巨核细胞数为[476.00(259.00,684.00)]个/骨髓片,无效(NR)组初诊巨核细胞数为[58.00(47.00,89.00)]个/骨髓片。住院时间为[5.00(4.00,12.00)]d;单用GCs组反应时间为[4.00(3.00,10.00)]d,GCs联合IVIG组反应时间为[3.00(2.00,8.00)]d。随访至6个月,CR 86例(57.33%),R 58例(38.67%),NR 6例(4.00%)。单用GCs组及GCs联合IVIG组比较,GCs联合IVIG组反应时间明显较短,差异有统计学意义(P<0.05);随访至6个月,两组患儿疗效差异无统计学意义(P>0.05)。巨核细胞数较多者,预后较好,差异有统计学意义(P<0.05)。结论ITP患儿以学龄前儿童更为常见,男孩多于女孩。GCs联合IVIG比单用GCs治疗反应时间短,预后无明显差异。初诊时骨髓巨核细胞数目低,提示预后不良。不同血小板膜蛋白特异性抗体阳性预后有差异,其中GPⅡb/GPⅢa阳性预后较好,GPⅠb/GPⅨ阳性预后欠佳。Objective To improve the understanding of the clinical features and prognosis of children with primary immune thrombocytopenia(ITP),so as to provide evidence for the diagnosis and treatment of children with ITP.Methods A total of 150 newly diagnosed ITP children admitted to Taian Central Hospital from October 2019 to June 2021 were analyzed retrospectively,and followed up until 6 months after onset.According to the platelet count,they were divided into two groups:the glucocorticoids(GCs)alone group(patients with nonsevere ITP),and the GCs combined with intravenous immunoglobulin(IVIG)(patients with severe ITP).The data including age,sex,platelet membrane protein-specific antibody at first diagnosis,bone marrow megakaryocyte number at first diagnosis,treatment response and prognosis and so on were analyzed.Results The onset age of 150 children with newly diagnosed ITP was(4.50[0.25,13.00])years,including 82 males(54.67%)and 68 females(45.33%).Platelet membrane protein-specific anti-GPⅠb antibody was positive in 32 cases(21.33%),anti-GPIX antibody in 15 cases(10.00%),anti-GPⅡb antibody in 86 cases(57.33%),anti-GPⅢa antibody in 76 cases(50.67%)and anti-GMP-140 antibody in 23 cases(15.33%).The initial megakaryocyte count in the complete response(CR)+response(R)group was(476.00[259.00,684.00])cells/bone marrow slice,and the initial megakaryocyte count in the non-response group(NR)was(58.00[47.00,89.00])cells/bone marrow slice.Hospital stay was(5.00[4.00,12.00])d.The reaction time of GCs alone group was(4.00[3.00,10.00])d,and reaction time of GCs combined with IVIG group was(3.00[2.00,8.00])d.Follow-up until 6 months after onset showed that 86 cases(57.33%)had complete response,58 cases(38.67%)had response,and 6 cases(4.00%)had no response to treatment.The reaction time of GCs combined with IVIG group was significantly shorter than that of the GCs alone group,with statistically significant difference(P<0.05).Follow-up until 6 months after onset showed that there was no significant difference in efficacy between t

关 键 词：儿童 原发性免疫性血小板减少症 血小板膜蛋白特异性抗体 预后 

分 类 号：R725.5[医药卫生—儿科]