儿童急性特发性血小板减少性紫癜不同治疗方案疗效及预后因素研究

目的分析儿童急性特发性血小板减少性紫癜（ITP）不同治疗方案的疗效,并探讨影响其远期预后的主要因素。方法分析2006年1月至2008年12月就诊于我院的72例儿童急性ITP患儿的不同治疗方案的近期疗效,并分析相关因素与患儿远期预后的关系。结果①泼尼松组显效率66.6%,有效率78.6%;无效9例（21.4%）;而丙种球蛋白组（丙球组）显效率90.0%,有效率96.7%,无效1例（3.3%）;丙球组的近期疗效明显优于丙球组（P〈0.05）;②丙球组的血小板开始上升时间、达峰值时间和恢复正常时间明显短于泼尼松组,而治疗第7天的血小板值则明显高于泼尼松组,显示丙球在早期提高血小板值方面的优势;③全组患儿中位随访56（12～70）个月,共有60例患儿治愈,12例患儿转为慢性ITP,不同治疗方式的预后转归无明显差异（P〉0.05）;④Logistic回归分析显示：患儿起病至开始治疗的时间、治疗后血小板开始上升的时间和血小板恢复正常的时间是影响预后的相关因素。结论对于儿童急性ITP患者应该早发现、早诊断、早治疗,特别是早期应用丙种球蛋白,可明显促进血小板的早期恢复,减少转为慢性ITP的可能性,应该作为一线治疗药物。

The efficiency of different therapy on acute idiopathic or immune thrombocytopenic purpura and its relevant prognostic factors in pediatric patients

Objective To explore the efficiency of different therapy in pediatric patients with acute idiopathic or immune thrombocytopenic purpura （ITP） and investigate its relevant prognostic factors.Methods Data of 72 pediatric patients with acute ITP who had admitted to our hospital from January 1,2006 to December 31,2008 were analyzed.The patients were divided into two groups：human immunoglobulin for intravenous injection （IVIG） group and prednisone （Pred） group,according to the treatment protocols which patients had accepted.We compared the early efficiency of the two therapies and analyzed its relevant prognostic factors.Results 1.The excellence rate and the effective rate in Pred group was 66.6% and 78.6%,respectively; and these in IVIG group was 90.0% and 96.7%,respectively.So the IVIG group was more efficient than the Pred group in the patients＇early reaction.2.In IVIG group,time to plate elevation,time to attaining the maximum of plate and time to plate normalization were all shorter than these in Pred group,while the plate level at the 7 day of treatment was higher than it in Pred group,which exhibit the superiority of IVIG in the early evaluation of plate.3.After a median follow-up of 56 months（range：12～70 months）,a total of 60 patients were cured and 12 patients converted to chronic ITP,and there was no statistic difference in the patients＇prognosis （P〉0.05）between the two groups.4.The logistic regression analysis demonstrated that time to accepting treatment,time to plate elevation and time to plate normalization were all associated with patients＇prognosis.Conclusion In pediatric patients with acute ITP,early diagnosis and treatment were very important,especially the early use of IVIG,which could evaluate the level of plate rapidly and reduce the convert ratio of chronic ITP.