免疫性血小板减少症脾切除治疗

目的:探讨免疫性血小板减少症(ITP)患者脾切除术后预后的影响因素。方法:回顾性分析31例行脾切除术治疗的ITP患者,统计分析患者的疗效,包括显效、良效、进步、无效,并对性别、年龄、脾脏大小、对激素治疗的反应、术前病程时长、术前血小板计数、手术方式等相关因素进行分析。结果:31例患者中,25例采用腹腔镜术式,6例采用开腹手术;中位随访时间29个月,显效21例(67.7%),良效5例(16.1%),进步3例(9.7%),无效2例(6.5%),无一例死亡。年龄≤30岁的患者显效率明显高于年龄30岁的患者(P=0.046),术前血小板计数≥20×10~9/L的患者显效率明显高于术前血小板计数20×10~9/L的患者(P=0.018)。结论:脾切除术是一种治疗ITP安全、有效的治疗方法。年龄小于30岁和术前血小板计数高于20×10~9/L是对ITP脾切除术疗效有利的影响因素。     

免疫性血小板减少性紫癜患者血小板输注疗效影响因素分析

目的:研究免疫性血小板减少性紫癜(ITP)患者血小板输注效果的影响因素,提高血小板输注有效率,减少血液资源浪费。方法:选取ITP患者166例,收集相关临床资料,通过单因素分析判断患者性别、病程、血小板输注次数、出血、脾肿大、糖皮质激素、丙种球蛋白使用、促红细胞生长素(TPO)应用、血小板制剂种类等是否影响血小板输注有效性。根据单因素分析结果,再进行多因素Logistic回归分析,判断血小板输注无效(PTR)的独立危险因素。结果:166例患者共输注单采血小板865人次,混合浓缩血小板1 480单位(148人次),血小板输注有效769人次,有效率75.91%,PTR 244人次,无效率24.09%。血小板输注次数、病程、脾肿大、TPO与血小板输注疗效,单因素分析χ²值分别为4.364、4.828、11.516、5.376,均P<0.05。性别、出血、糖皮质激素、丙种球蛋白、血小板制剂与血小板输注疗效,单因素分析χ²值分别为0.308、1.319、2.062、2.495、0.486,均P>0.05。多因素Logistic回归分析显示血,...     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。     

肺挫伤所致急性呼吸窘迫综合征预后相关因素的Logistic分析

目的探讨肺挫伤所致急性呼吸窘迫综合征患者病死率密切相关的影响因素。方法 112例肺挫伤所致急性呼吸窘迫综合征患者的各项临床指标进行统计分析以明确影响病死率的独立相关因素,根据患者预后,分为生存组和死亡组。研究的因素包括性别、年龄、伤后时间、是否合并多发伤、是否发生低血容量性休克、血小板计数、手术与否、血糖值、有无合并基础疾病、ISS评分及TSS评分。应用单因素、多因素Logistic回归分析肺挫伤所导致的急性呼吸窘迫综合征。结果两组间性别、手术与否差异无统计学意义(P0.05),而年龄、伤后时间、低血容量休克、血小板计数、血糖、存在基础疾病、ISS评分及TSS评分差异有统计学意义(P0.05)。多因素Logistic分析发现,影响此类患者预后的独立危险因素为年龄≥60岁、伤后时间、合并多发伤、低血容量休克、血小板计数≤80×109/L、有基础疾病、ISS≥30分和TSS≥15分。结论肺挫伤所致急性呼吸窘迫综合征病死率高,以上独立危险因素可以为正确判断病情提供重要依据。     

肝硬化合并门静脉血栓形成危险因素的病例对照研究

[目的]:旨在探讨分析影响肝硬化合并门静脉血栓形成的相关危险因素。[方法]选取我院2015年1月~2016年10月收治的肝硬化合并门静脉血栓患者53例作为观察组,另选取同期肝硬化未合并门静脉血栓者72例作为对照组,收集2组患者的临床资料,采用Logistic回归分析模型分析影响肝硬化合并门静脉血栓形成危险因素。[结果]观察组患者血小板计数、Child-Pugh评分明显高于对照组(P0.05);肝切除史、合并高血压、糖尿病及出现黑便/呕血者明显高于对照组(P0.05);单因素分析显示血小板计数、血白蛋白、脾切除史、Child-Pugh评分、合并高血压、合并糖尿病、门静脉内径、饮酒史、腹水、CHE是影响肝硬化PVT形成的危险因素(P0.05);经Logistic回归模型分析结果显示:血白蛋白30g/L、脾切除史、门静脉内径1.0cm、腹水、高Child-Pugh评分是肝硬化合并PVT形成的独立危险因素(P0.05)。[结论]高血白蛋白、脾切除史、门静脉内径增宽、腹水、肝功能差是影响肝硬化合并门静脉血栓形成的危险因素。     

重型肝炎预后危险因素Logistic回归分析及预后模型的建立

目的研究重型肝炎患者预后的危险因素,建立预后判断模型。方法回顾性收集2008年6月至2011年6月在广西医科大学第八附属医院收治的145例重型肝炎患者的临床资料,运用Logistic进行单因素和多因素分析,建立预后模型。用独立的临床肝病资料进行验证,评判模型判断能力。结果 145名患者中好转54例,死亡91例,病死率62.8%(94/145)。Logistic回归分析结果显示肝性脑病、腹水、肌酐、血氨、凝血酶原活动度是独立危险因素。对构建的预后判断模型的预测能力进行研究发现:模型预测的灵敏度为92.0%,特异度为88.0%,总正确率为90.0%。结论肝性脑病、腹水、肌酐、血氨、凝血酶原活动度作为独立的危险因素可用于预后判断模型的构建。本研究构建的预后模型能够较为准确的预测重型肝炎患者的短期预后。     

低分子肝素皮下注射治疗肝硬化并门静脉血栓未再通的高危因素分析

目的分析低分子肝素皮下注射治疗肝硬化并门静脉血栓(PVT)未再通的高危因素。方法选取2014年1月至2016年10月在我院诊治为肝硬化并PVT住院治疗的108例患者资料行回顾性分析,所有患者均采取低分子肝素皮下注射进行血栓溶解,根据血栓有无再通分为再通组和未再通组,将两组患者的不同临床资料进行单因素分析,找出可能危险因素,将可能危险因素经多因素Logistic回归分析,得出肝硬化并PVT未再通的独立高危因素。结果 108例肝硬化并PVT患者血栓完全溶解62例(57.41%),部分溶解31例(28.70%),未溶解15例(13.89%)。单因素分析显示未再通组的年龄、脾切除史、中性粒细胞、肝功能Child评分、门静脉直径、血小板(PLT)水平、凝血酶原时间(PT)值、D-二聚体(D-D)值均高于再通组(均P0.05),未再通组的血红蛋白(Hb)水平低于再通组(P0.05)。多因素Logistic回归分析显示脾切除史、肝功能Child评分、门静脉直径、PLT水平、D-D水平和Hb水平为肝硬化并PVT患者血栓未再通的独立危险因素(P0.05)。结论脾切除史、肝功能Child评分高、门静脉直径大、PLT水平高、D-D水平高及Hb水平低是肝硬化并PVT患者采用低分子肝素治疗后血栓再通失败的独立危险因素。     

原发免疫性血小板减少患者确诊后半年内呼吸道感染的临床危险因素分析

目的分析原发免疫性血小板减少患者确诊后半年内呼吸道感染的临床危险因素,为其防治提供参考。方法以2014年1月-2017年6月期间本院确诊的238例原发免疫性血小板减少症患者为回顾性研究对象,收集其临床资料(年龄、性别、糖皮质激素应用情况、脾切除治疗情况、是否合并贫血症、是否吸烟史、肺功能是否正常、骨髓巨核细胞数是否正常、血小板抗体检测阴、阳性及呼吸道感染情况等),并进行单因素分析及多因素非条件Logistic回归分析。结果 238例原发免疫性血小板减少患者中,半年内合并呼吸道感染51例,占比21.43%。经单因素分析、多因素非条件Logistic回归分析显示,糖皮质激素应用、脾切除、吸烟史、肺功能异常、骨髓巨核细胞数异常、血小板抗体阳性,是原发免疫性血小板减少患者确诊后半年内继发呼吸道感染的临床危险因素。结论原发免疫性血小板减少患者确诊后半年内继发呼吸道感染率较高,临床危险因素相对较多,需结合临床实际采取针对性防治措施,以降低感染发生率,提升患者生活质量。     

老年门脉高压性脾功能亢进患者脾切除术后并发门静脉血栓的危险因素

目的探讨老年门脉高压性脾功能亢进患者行脾切除术后并发门静脉血栓(PVT)的危险因素。方法回顾性分析行脾切除术的46例老年肝硬化后门脉高压性脾功能亢进病例的临床资料,分为PVT组6例与非PVT组40例,分别采用单因素分析与多因素Logistic回归分析形成PVT的危险因素。结果门静脉直径、脾静脉直径、术后血小板计数和术后门静脉血流速是术后PVT的独立危险因素。结论应积极预防门静脉直径大、脾静脉直径大、术后门静脉血流速慢和术后血小板计数高的老年门脉高压性脾功能亢进患者术后形成PVT。     

脾大部栓塞治疗难治性特发性血小板减少性紫癜12例临床分析

目的:观察脾大部栓塞治疗难治性特发性血小板减少性紫癜(ITP)患者的临床疗效。方法:选择12例难治性ITP住院患者,给予脾大部栓塞治疗。结果:12例患者治疗后1周,血小板显著升高,达(123~257)×109/L,缓解率100%。随访时间12个月,显效2例,血小板长期维持正常水平。良效5例,血小板计数长期维持(50~100)×109/L。5例于3~6个月复发,其中2例再行激素治疗后有效;1例CT显示脾脏栓塞面积不足50%,行第2次脾栓塞并维持小剂量激素控制较好。另2例口服硫唑嘌呤,并小剂量泼尼松,病情得到有效控制。结论:对于难治性ITP患者,脾大部栓塞治疗可能有效。     

Response to splenectomy is durable after a certain point in time in adult patients with chronic immune thrombocytopenic purpura

Splenectomy may lead to a good response in 60-80% of adult patients with corticosteroid refractory idiopathic thrombocytopenic purpura (ITP) but, the long-term response to splenectomy still remains less well defined. We assessed the long-term efficacy and safety of splenectomy in adult patients with chronic ITP. A cohort of 59 splenectomised ITP patients (M/F = 25/34; median age 39 yr; range 14-75) were followed up for a median of 18 yr (range 2-32). No life-threatening surgical complications were observed. The overall response rate was 78% with 59% complete remission (CR) and 19% partial remission (PR). CR and PR patients were younger than non-responding patients at time of diagnosis (median age: 36 yr vs 48 yr, P = 0.03) and at splenectomy (median age: 38 yr vs 51 yr, P = 0.02). Among the 46 responding patients, eventually 17 had relapse. No disease progression occurred after 12.1 and 7.3 yr for patients in CR or PR, respectively. One case of fatal septicaemia was recorded. We conclude that splenectomy is an effective and safe treatment in adult patients with chronic ITP failing to respond to corticosteroid treatment and importantly, our findings support the view that response to splenectomy is durable after a certain point in time.     

Idiopathic thrombocytopenic purpura occurring in Hodgkin disease after splenectomy: report of two cases and review of the literature

The occurrence of idiopathic thrombocytopenic purpura (ITP) in Hodgkin disease is uncommon. Even more unusual is the development of ITP in Hodgkin disease following splenectomy. This report describes two patients with Hodgkin disease who developed severe ITP with negative platelet antibody studies very soon after splenectomy (20 days in one and three months in the other). A review of the literature of 21 other patients with well-documented ITP and Hodgkin disease indicated that ITP occurring in Hodgkin disease may be more severe and refractory to therapy than ITP unassociated with Hodgkin. Nodular sclerosis or mixed cellularity histologic types of Hodgkin disease were present in all but one of the patients with ITP and Hodgkin disease, and males constituted 65% of cases. There appeared to be no correlation between the onset of ITP and activity of Hodgkin disease. Of five splenectomized patients with Hodgkin disease who developed ITP and were treated with immunosuppressive drugs for thrombocytopenia, three had an excellent response and two had a good response, suggesting that the combination of corticosteroids and immunosuppressive drugs may be indicated at the outset in patients with Hodgkin disease who develop ITP following splenectomy.     

Idiopathic thrombocytopenic purpura in elderly patients: a study of 47 cases from a single reference center

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is often diagnosed in the elderly, but no specific guidelines exist for such patients. We describe our experience with ITP management in elderly patients and analyze the therapeutic response. METHODS: We retrospectively reviewed a cohort of 47 consecutive elderly ITP patients (> or =60 years old) followed in a single reference center. We specifically analyzed the clinical characteristics, therapies used, patient response rates, and side effects. RESULTS: The mean age of the 47 patients was 66 (range 60-82) years; 31 patients were female. Their initial presentation included bleeding limited to the skin (n=10, 21%) and bleeding at one or more other sites (n=26, 56%); 11 patients (23%) were asymptomatic. The mean platelet count was 52 x 10(9)/L (range 1-120 x 10(9)/L). After 1 and 6 months, the overall response rate was: 61% and 33% with corticosteroids (n=43), 80% and 50% with splenectomy (n=10), and 14% and 60% with danazol (n=15), respectively. Side effects of these therapies were reported in 100% of these elderly ITP patients, 60% and 50% with these drugs, respectively. No response was reported using IVIg. One case of fatal sepsis was noted after splenectomy. CONCLUSIONS: The results confirm (1) that age influences the hemorrhagic pattern of ITP expression, response, and adverse effects of conventional ITP therapies, and (2) that danazol has the potential to be an effective therapeutic alternative to splenectomy in elderly ITP patients.     

T lymphocyte subsets and platelet-associated IgG in idiopathic thrombocytopenic purpura: effect of splenectomy

The modifications of cell-mediated immunity in idiopathic thrombocytopenic purpura (ITP) were investigated using the technique of Moretta et al. [J. exp. Med. 151: 969-974, 1980] to study T lymphocyte subsets in 35 ITP subjects at various clinical stages. In all these patients, platelet-associated IgG (PAIgG) were measured by a complement lysis inhibition technique. Untreated ITP patients did not show significant modifications of T lymphocyte subsets. Patients with thrombocytopenia not responsive to corticoids or splenectomy and increased PAIgG levels showed significant reduction of Fc-gamma-bearing T lymphocytes (T-gamma). Patients 'cured' by splenectomy (12 out of 17) showed a normal PAIgG level, a marked increase of T-gamma cells and a reduction of T-mu cells; patients 'not cured' by splenectomy showed an increased PAIgG level and a reduction of T-gamma cells. An increase of PAIgG levels and a reduction of T-gamma cells were found in 2 splenectomized patients after relapse. An association between chronic nonresponsive ITP and decrease of T-gamma cells was established.     

The scintigraphic index spleen/liver at 30 minutes predicts the success of splenectomy in persistent and chronic primary immune thrombocytopenia

Splenectomy is considered the second-line of treatment in patients with chronic primary immune thrombocytopenia (ITP) in whom glucocorticoids have failed. Some patients do not respond to splenectomy or they have postoperative complications. Based on our previous experience using kinetic and scintigraphic parameters, we did a retrospective study with the aim of comparing all these parameters as a means of predicting the success of splenectomy in persistent and chronic primary ITP. Forty-one consecutive patients with chronic primary ITP refractory to prednisone, who had been splenectomized, were included in the study. The response to splenectomy was assessed by evaluating bleeding and platelet counts before and at different times after surgery. A complete platelet kinetic study was performed before the splenectomy using autologous (111) In-labeled platelets. The scintigraphic parameters measured included different indices between spleen/heart, liver/hearth, and spleen/liver. Thirty-six patients gave a complete response after splenectomy and five patients did not respond. A statistically significant difference between both groups was found with initial platelet recovery and with some scintigraphic indices which also showed a variable prediction value for the success of splenectomy. Among these indices, the spleen/liver at 30 minutes demonstrated a predictive value with a 100% of sensitivity and a 100% of specificity. Conclusion: some platelet kinetic parameters and scintigraphic indices, in particular the spleen/liver at 30 minutes, were useful to predict the outcome of splenectomy in persistent and chronic primary ITP and, therefore, they should be taken into account when deciding whether or not to perform a splenectomy.     

Danazol therapy in patients with chronic idiopathic thrombocytopenic purpura: long-term results

BACKGROUND: Adults with chronic idiopathic thrombocytopenic purpura (ITP) in whom standard-dose corticosteroids and splenectomy have failed or who have contraindications to these therapies often require further treatment for life-threatening thrombocytopenia or bleeding. We studied whether danazol, an attenuated androgen, is useful in this setting. METHODS: To assess both clinical outcome and tolerance issues, 57 patients who had refractory chronic ITP (n = 27) or who had contraindications to splenectomy or corticosteroids or who refused these therapeutic options (n = 30) were studied. RESULTS: Thirty-eight patients experienced a partial or complete response to therapy (67%), among whom 27 (46%) remained in remission at a median (+/- SD) of 119 +/- 45 months. Treatment tolerance was acceptable, although severe adverse events were reported in 9 patients (16%). CONCLUSION: Our findings suggest that danazol therapy may be beneficial in the management of refractory chronic ITP or when there are contraindications to splenectomy or corticosteroids (or both).     

5- to 16-year follow-up following splenectomy in chronic immune thrombocytopenic purpura in children

The long-term outcome after splenectomy in children with chronic immune thrombocytopenic purpura (ITP) has not been widely analyzed. We reviewed the medical records of 288 children and adolescents with chronic ITP between 1980 and 1996: 112 were splenectomized; 59 were steroid resistant and 42 were steroid dependent, and 11 were managed with repeated courses of intravenous immunoglobulin (IVIG). All had platelet counts (PCs) <30 x 10(9)/l with frequent bleeding episodes or persistent thrombocytopenia <10 x 10(9)/l. Ninety-eight patients (88%) were evaluated; 58 (60%) patients had never received immunotherapy for ITP following splenectomy. At 5 years, 44 (45%) remained in complete response (CR) and 34 (35%) in partial response (PR). In multivariate analysis, steroid-resistant patients were more likely to relapse after an initial CR (RR 5.2). CONCLUSION: The long-term CR was 45%; 60% had stable PCs >30 x 10(9)/l not requiring therapy. Most postsplenectomy relapses occurred during the 1st year. Initial response to steroids and IVIG prior to splenectomy was a predictor of long-term response to splenectomy.     

Cyclosporin A for the treatment of patients with chronic idiopathic thrombocytopenic purpura refractory to corticosteroids or splenectomy

Patients with chronic immune thrombocytopenic purpura (ITP) who are unresponsive to corticosteroids require splenectomy, but if this fails, treatment is difficult. We tried to induce durable remissions in ITP patients refractory to corticosteroids before or after splenectomy by applying strong immunosuppression with the combination of cyclosporin A (CyA 5 mg/kg/d) and prednisone (0.4 mg/kg/d). Patients were assigned to one of two groups. Group 1, 10 patients refractory to prednisone; and group 2, 10 patients refractory to at least prednisone and splenectomy. Overall response rate was 55% (50% in group 1 and 60% in group 2 patients). Nine of the 10 patients in group 1 finally had a splenectomy because of relapse, insufficient response or toxicity of CyA. Thirty percent of the patients discontinued CyA because of side-effects; hypertension, severe headache and muscle pain being the most frequent encountered. It is concluded that CyA treatment does not avoid, but only postpones, splenectomy in chronic ITP patients who are refractory to corticosteroids. However, CyA can be useful in a subgroup of patients with corticosteroid- and splenectomy-refractory ITP, but treatment toxicity is high.     

Lack of useful clinical predictors of response to splenectomy in patients with chronic idiopathic thrombocytopenic purpura

We set out to identify clinical or analytical variables that might predict the response to splenectomy in patients with chronic idiopathic thrombocytopenic purpura (ITP). We retrospectively examined 138 mostly adult patients with chronic ITP, treated with splenectomy. Information was compiled from five Public Health Hospitals from a questionnaire and chart review. Sixty-one potentially prognostic variables were analysed by univariate and multivariate statistical methods. After multivariate analysis, age (relative risk = 1.02; CI 1-1.03) and a severity of the bleeding diathesis (relative risk = 1.6; CI 1.13-2.22) were independent prognostic factors for a sustained response to splenectomy. An independent analysis of the postsplenectomy counts showed that an early (days 1-3) thrombocyte count exceeding 156 x 10(9)/l cells increases the likelihood of a permanent unmaintained response. Our data indicate that the response to splenectomy in patients with chronic ITP cannot be adequately predicted on the basis of pre-splenectomy clinical or analytical variables.     

Rituximab efficacy and safety in adult splenectomy candidates with chronic immune thrombocytopenic purpura: results of a prospective multicenter phase 2 study

Whether rituximab could effectively and safely avoid splenectomy for adults with chronic immune thrombocytopenic purpura (ITP) remains unresolved. A multicenter, prospective, open-label, single-arm, phase 2 trial was conducted to assess rituximab safety and efficacy in adult splenectomy candidates with chronic ITP. Sixty patients with chronic (>or= 6 months) ITP and platelet counts less than 30 x 10(9)/L received a weekly intravenous infusion of rituximab (375 mg/m(2)) for 4 weeks. All other ITP treatments were stopped. A good response was defined as a platelet count 50 x 10(9)/L or more, with at least a doubling of the initial value at 1 and 2 years after the first rituximab infusion. Patients who required another treatment during follow up were considered nonresponders. Sixteen patients experienced transient side effects that necessitated treatment discontinuation for only 1. Good 1-year responses were obtained in 40% of the patients (24/60 [95% confidence interval: 28%-52%]). At 2 years, 33.3% (20/60 patients) had good responses and 6.7% (4/60) had sustained platelet counts of 30 x 10(9)/L or more without treatment. Thirty-six (60%) patients failed to respond; 25 underwent splenectomy. Based on these results, rituximab was an apparently safe and effective splenectomy-avoiding option in some adults with chronic ITP. This trial is registered at http://clinicaltrials.gov as NCT00225875.