两种出血评分量表在儿童原发性免疫性血小板减少症中的临床应用  

Clinical Application of Two Bleeding Scoring Scales in Children with Primary Immune Thrombocytopenia

作　　者：刘福 杜春燕[2] 胡陶[2] 刘文君[1] LIU Fu;DU Chun-Yan;HU Tao;LIU Wen-Jun(Department of Pediatrics,The Affiliated Hospital of Southwest Medical University,Sichuan Clinical Research Center for Birth Defects,Luzhou 646000,Sichuan Province,China;Department of Pediatrics,Mianyang Central Hospital,Mianyang 621000,Sichuan Province,China.)

机构地区：[1]西南医科大学附属医院儿科,四川省出生缺陷临床医学研究中心,四川泸州646000 [2]绵阳市中心医院儿科,四川绵阳621000

出　　处：《中国实验血液学杂志》2024年第5期1524-1530,共7页Journal of Experimental Hematology

摘　　要：目的:探讨儿童原发性免疫性血小板减少症(ITP)诊疗规范(2019年版)的出血评分量表(2019版儿童ITP评分量表)在儿童ITP中的临床应用价值。方法:采用2019儿童ITP评分量表及ITP特异性出血评价工具(2013 ITP-BAT)对422例ITP患儿进行出血评分并统计其临床资料,分析两种出血评分系统与疾病分期、血小板计数的相关性比较两种评分方法的评估时间、评价一致性,分析两者的相关性。分析治疗前与治疗后48 h、1周血小板计数及出血评分的变化,以检测2019儿童ITP评分量表的反应度。结果:2019儿童ITP评分量表评分以1分及2分为主,对应出血为皮肤及黏膜出血,404例(95.7%)患者有出血表现其中皮肤出血249例(59.0%),黏膜出血144例(34.1%),器官出血11例(2.6%)其中2例(0.5%)患儿严重出血。两种出血评分与ITP患儿的血小板计数呈负相关(r_(s)=-0.5032,r_(s)=-0.6084),与疾病分期均无相关性(P> 0.05)。2019儿童ITP评分量表与2013ITP-BAT具有较好的一致性(r_(s)=0.7638),但2019儿童ITP评分量表评分所需平均时间[88.64(40-181)秒]低于2013 ITP-BAT [104.12(47-285)秒](Z=17.792,P<0.001)。2019儿童ITP评分量表能很好反应儿童ITP的治疗情况。激素组、丙球组、激素联合丙球组治疗前与治疗后48 h、1周血小板计数比较差异均具有统计学意义(P<0.05),3组患儿治疗前与治疗后1周的2019儿童ITP评分量表评分比较差异均具有统计学意义(P <0.05)。结论:2019儿童ITP评分量表在临床应用中具有良好的一致性及反应度,与2013 ITP-BAT比较评分所需时间短,可作为病情评估、疗效判定的有效工具。Objective:To explore the clinical application value of the Bleeding Scoring Scales(2019 Pediatric ITP Scale)in the diagnosis and treatment of children with primary immune thrombocytopenia(ITP).Methods:A total of 422 children with ITP were evaluated with the 2019 Pediatric ITP Scale and the 2013 ITP-BAT and their clinical data were analyzed.The correlation between the two bleeding scoring scales and disease stage,platelet count was analysed,the evaluation time,consistency of the two bleeding scoring scales was compared,and the correlation of the two methods.The changes of platelet count and the score of 2019 Pediatric ITP Scale before treatment and after treatment at 48 h and one week were analyzed to detect responsiveness of the 2019 Pediatric ITP Scale.Results:The score of the 2019 Pediatric ITP Scale was mainly one point and two points,the corresponding bleeding was skin and mucosal bleeding.404 patients(95.7%)had bleeding manifestations,including 249 patients of skin bleeding(59.0%),144 patients of mucosal bleeding(34.1%),and 11 patients of organ bleeding(2.6%),of which 2 patients were severe bleeding.The two bleeding scoring scales were both negatively correlated with platelet counts in children with ITP(r_(s)=-0.5032,r_(s)=-0.6084)and no correlation with the stage of pediatric ITP(P>0.05).The 2019 Pediatric ITP Scale had good consistency with the 2013 ITP-BAT(r_(s)=0.7638).The average time required for the 2019 Pediatric ITP Scale.was 88.64(40-181)seconds,which was lower than that required for the 2013 ITP-BAT 104.12(47-285)seconds(Z=17.792,P<0.001).The 2019 Pediatric ITP Scale can well reflect the treatment of pediatric ITP.There were statistically significant differences in platelet count before treatment and after treatment at 48 h and one week among steroid group,IVIG group and steroid combined with IVIG group(P<0.05).There were also statistically significant differences in the score of the 2019 Pediatric ITP Scale before treatment and after treatment at one week among the three groups(P<0.05).Conclusion

关 键 词：儿童 原发性免疫性血小板减少症 出血评分 血小板计数 

分 类 号：R558.2[医药卫生—血液循环系统疾病]