成人原发性免疫性血小板减少症170例临床分析

目的探讨成人原发性免疫性血小板减少症(ITP)患者发病的临床特点、治疗反应及影响因素等。方法回顾性分析ITP患者170例的年龄、性别、初始症状、治疗方法、效果以及相关不良反应。结果 170例ITP患者中位发病年龄为38岁;男女比例为l∶1.68,60岁的男女比例为1∶2.1,≥60岁男女比例为l∶1.4。出血的部位依次为:皮肤(40%),黏膜(34.7%),月经增多(10.6%),无出血症状(10.6%),内脏出血(4.1%)。低年龄组(60岁)无出血症状比例显著高于高年龄组(≥60岁),内脏出血比例显著低于高年龄组(P0.05)。170例ITP患者初诊时血小板计数中位数为5×109L-1,骨髓巨核细胞增多者106例(77.4%)。治疗效果:糖皮质激素总有效率85.7%,HDIVIG 82.1%,达那唑76.5%,免疫抑制剂11.1%,脾切除66.7%。高年龄组糖皮质激素总有效率与低年龄组相仿(P0.05)。骨髓巨核细胞增多者疗效明显优于巨核细胞正常或减少者(P0.05)。结论成人ITP好发于年轻女性,60岁以后男女发病比例接近;皮肤黏膜出血是最常见的临床表现,但老年ITP患者更易引起致命出血;糖皮质激素仍然是目前治疗ITP的首选药物,治疗前巨核细胞增多者疗效好;老年患者对激素反应良好,但需注意防治相关不良反应。

Clinical characteristics of adult patients with immune thrombocytopenia

Objective To explore the clinical characteristics,treatment responses,adverse drug reactions and influencing factors of adult patients with primary immune thrombocytopenia(ITP).Methods A total of 170 cases of hospitalized adult patients with ITP were analysed in terms of age,gender,the initial symptoms,treatments,treatment effects and treatment-related adverse reactions.Results Median age of 170 ITP cases was 38 years old;proportion of male and female was l:1.68,<60 years was 1:2.1,≥60 years was l:1.4.Bleeding sites were: skin(40%),mucous membrane(34.7%),increased menstruation(10.6%),no bleeding symptoms(10.6%),visceral bleeding(4.1%).The ratio of no bleeding symptoms in lower age groups(< 60 years) was significantly higher,the ratio of visceral bleeding was significantly lower than that in higher age groups(≥60 years)(P<0.05).Median platelet counts in 170 patients with ITP was 5×109L-1,the number of patients with bone marrow megakaryocyte increased was 106(77.4%).Total effective ratios were(treatment effects): glucocorticoid(85.7%),HDIVIG(82.1%),danazol(76.5%),splenectomy(66.7%),immunosuppressant(11.1%).The effective ratio of glucocorticoid in higher age groups was always similar to that in lower age groups(P>0.05).Therapeutic effect of patients with bone marrow megakaryocyte increased was significantly better than that of patients with megakaryocyte normal or reduced(P<0.05).Conclusion ITP is often diagnosed in the younger female(age<60 yr);skin and mucosal hemorrhage are the commonest clinical manifestations,but the elder ITP patients are more likely to suffer fatal hemorrhage;glucocorticoid is still the preferred drug for treatment of ITP.Therapeutic effect of patients with bone marrow megakaryocyte increased is better;the elder ITP patients have good reactions to glucocorticoid,but doctors must pay attention to the prevention of the treatment-related adverse reactions.