Objective: To investigate the factors affecting the chronicity of childhood primary immune thrombo-cytopenia (ITP) and compare the efficiency of different first-line treatment regimens.
Methods: Children with ITP hospitalized in our hospital from September 2013 to October 2018 were retrospectively analyzed.
Results: Three hundred and one children (150 males and 151 females) were included in this study, with a median age of 8 (0.17-17) years old, and 110 (36.5%), 92 (30.6%), and 99 (32.9%) cases were grouped into newly diagnosed, persistent, and chronic ITP, respectively. The median of follow-up was 41.92 (1.07-74.03) months. At the end of the follow-up (October 2019), among the 202 newly diagnosed/persistent ITP children, 79 cases (59 newly diagnosed and 20 persistent ITP) achieved remission within 1 year after initial diagnosis, with a remission rate of 39.3%; 122 cases (50 newly diagnosed and 72 persistent ITP) developed chronic disease, with a chronicity rate of 60.7%; one case underwent splenectomy. In 99 cases with chronic ITP, 5 cases underwent splenectomy. Multivariable logistic regression analysis showed that, the insidious onset of symptoms (OR=3.754, 95%CI: 1.882-7.488, P=0.000) increased the risk of chronicity, while the positive antibody to anti-platelet membrane glycoprotein (OR=0.446, 95%CI: 0.224-0.888, P=0.021) might reduce the risk of chronicity. And no difference was found by the analysis of subtype of anti-platelet membrane glycoprotein (P=0.305). The efficacy of the first-line treatment of intravenous immunoglobulin (IVIG) alone or combined with steroid was better than that of steroid alone (P=0.028, 0.028), however, the efficiency was not significantly different between IVIG alone and combined with steroid (P=0.086).
Conclusion: Insidious onset of symptoms in pediatric ITP increases the risk of chronicity, while the positive titer of anti-platelet membrane glycoprotein may reduce the risk. In the first-line treatment for the newly diagnosed/persistent children. The efficacy of IVIG alone or combined with steroid is better than that of steroid alone.
题目: 原发免疫性血小板减少症住院患儿临床分析.
目的: 研究儿童原发免疫性血小板减少症（ITP）慢性化的影响因素，比较不同一线治疗方案的疗效.
方法: 回顾性分析2013年9月至2018年10月于本院住院治疗的ITP患儿的临床资料.
结果: 共计301例ITP患儿纳入研究。男150例，女151例，中位年龄8（0.17-17）岁。新诊断ITP 110例（36.5%），持续性ITP 92例（30.6%），慢性ITP 99例（32.9%）。中位随访时间41.92（1.07-74.03）个月。截至随访终点（2019年10月），202例新诊断/持续性ITP患儿中，79例（59例新诊断ITP，20例持续性ITP）在初诊后1年内获得缓解，缓解率39.3%；122例（50例新诊断ITP，72例持续性ITP）进展为慢性ITP，慢性化率60.7%；1例行脾切除。99例慢性ITP患儿中，5例行脾切除。多因素Logistic回归分析显示，隐匿起病(OR=3.754,95%CI:1.882-7.488,P=0.000)增加疾病慢性化风险，而血小板膜糖蛋白抗体阳性(OR=0.446,95%CI:0.224-0.888,P=0.021)降低慢性化风险，抗体类型的亚组分析无差异（P=0.305）。新诊断和持续性ITP仅接受一线治疗的患儿，单独应用静脉注射免疫球蛋白（IVIG）或IVIG联合激素疗效均优于激素单药治疗（P=0.028，0.028），而单独应用IVIG与IVIG联合激素比较疗效无差异（P=0.086）.
结论: 儿童ITP隐匿起病慢性化风险升高，血小板膜糖蛋白抗体阳性降低慢性化风险。儿童新诊断和持续性ITP的一线治疗，单独应用IVIG或IVIG联合激素疗效均优于激素单药治疗.