摘要
目的通过分级治疗，探讨儿童急性原发性免疫性血小板减少症（ITP）的初始治疗指征。方法总结上海交通大学附属儿童医院2012年1月1日至2013年4月30日在血液专科诊治的新诊断ITP患儿380例。男214例（56．31％），女166例（43．68％）。以血小板计数≤30×10^9／L，或伴有中度以上出血现象以及活动性出血者划分为观察组和治疗组，观察组仅予每周观测血小板值，治疗组则予肾上腺皮质激素及丙种球蛋白治疗。随访至2013年8月30日，中位随访时间9个月。结果总有效305例（80．26％），无效75例（19．74％）。其中观察组178例（46．84％），有效133例（74．72％）；治疗组202例（53．16％），有效167例（82．67％）；2组疗效比较差异无统计学意义（Z=-0．54，P=0．59）。观察组中无效45例，进入药物治疗，有效35例（77．78％），与治疗组有效率比较差异无统计学意义（x^2=3．60，P=0．06）。2组患儿发病年龄、性别和季节构成差异无统计学意义。各年龄组中，1个月～1岁组以免疫接种为主要诱因，3～14岁组以感染为主要诱因。观察组和治疗组患者中3岁以上儿童是影响自愈和治疗无效的危险因素。本组患儿均未观察到严重出血和严重不良反应及死亡病例。结论以血小板计数≤30×10^9／L为分界作为初始治疗指征可行，可使50％的患儿避免接受过度治疗，先期观察后再治疗并未减弱早期疗效，严重脏器出血未见。
Objective To explore the initial therapy indications of acute immune thrombocytopenia （ITP） in children based on the classification treatment. Methods Three hundred and eighty newly diagnosed ITP cases were enrolled in this study from Jan. 1 s, 2012 to Apr. 30th 2013 in Children＇s Hospital Affiliated to Shanghai Jiaotong University. In total 380 patients, there were 214 male cases （56.31%） and 166 female cases （43.68%）. The cases were divided into observation group and therapy group according to the initial platelet count which was ≤ 30 × 10^9/L or the bleeding over moderate volume or with active bleeding. Platelet values were observed in the observation group weekly, adrenal cortical hormone and immunoglobulin treatment were adopted in the therapy group, cases were followed up to Aug. 30th 2013, 9 months on the average. Results Three hundred and five cases showed overall response （80.26%） and 75 cases showed no response（ 19.74% ）. One hundred and seventy-eight cases were divided into observation group （46.84%） ,in which 133 cases （74.72%） showed complete response or response. Two hundred and two cases were included in therapy group （53.16%） ,in which 167 cases （82.67 % ） were with complete response or response. There was no statistical difference between the 2 groups in curative effect （ Z = - 0. 54,P = 0.59） . Forty-five cases in observation group were no response and accepted therapy ,35 of them （77.78%） had response. There were equal efficiency in the initial therapy group and the subsequent therapy group （X^2 = 3.60, P = 0.06）. There was no difference between the age of onset, sex and season in 2 groups. Cases aged from 1 month to 1 year seemed to have a high incidence because of vaccination, and in the cases aged from 3 to 14 years the onset was related to infection. The children over 3 years old had higher risk factors in self-healing and the curative effect. There was no severe bleeding or adverse effect or dead cases in this study. Conclusions It is feasible to take platelet count ≤30 × 10^9/L as the threshold for initial therapy indications. Almost half of the cases could avoid overtreatment and pretherapy observation will not reduce the initial cure effect; no severe internal bleeding was observed in all the cases.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2014年第12期919-922,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
上海市科委重大课题子项目（12411952406）
上海市申康医院发展中心适宜技术项目（SHDC12012221）
