小儿特发性血小板减少性紫癜的有关临床特点

目的探讨小儿特发性血小板减少性紫癜(ITP)的临床特点。方法对我院收治的255例ITP患儿的临床资料进行分析。结果1、男:女=1.43,中位年龄31个月,2岁以下占47.06%;急性型占91.37%,慢性型占8.63%。2、47.84%有前驱感染病史,31.76%在发病前1~4周有预防接种史。3、病原学检查阳性率73.81%,其中HPVB1945.24%。4、预防接种疫苗中乙肝疫苗34.57%,百白破疫苗24.69%,麻疹疫苗8.64%。5、临床表现94.12%以轻、中度皮肤粘膜出血为主,重度出血仅占5.88%。6、就诊时血小板数量:平均22.47×109/L,≤20×109/L占56.47%。7、骨髓常规涂片巨核细胞总数增多的占77.06%,分类中成熟无血小板产生的巨核细胞数>原始幼稚巨核细胞数>成熟有血小板产生的巨核细胞数>裸核巨核细胞数。8、给予以肾上腺皮质激素为主的治疗,97.42%血小板在2周内达正常,复发率4.29%。9、疫苗相关ITP的中位年龄6月,就诊时平均血小板数量22.3×109/L,95.06%患儿为轻中度出血;骨髓巨核细胞数增多者占75.68%;病原学检查阳性率为85.71%,其中HPVB19占64.29%;93.83%患儿治疗后平均4.90天血小板恢复正常水平,复发率3.7%。结论1、小儿ITP患者大多数为急性型,预后良好。2、病毒感染与小儿ITP关系密切,HPVB19在小儿ITP发病中有重要意义。3、疫苗相关的ITP发生率高于以往报道,除发病年龄小外临床特点与其他ITP相似,相关疫苗中以乙肝、百白破疫苗多见,应引起注意。4、HPVB19阳性患儿临床特点与一般ITP大致相同。5、以肾上腺皮质激素为主的治疗方案治疗小儿ITP疗效显著;大剂量丙种球蛋白和大剂量肾上腺皮质激素对有严重出血或血小板极低的患儿止血效果明显,可以避免血小板输注和相关死亡的发生。

Clinical characteristics of idiopathic thrombocytopenic purpura in children

Objective To investigate the clinical characteristics of idiopathic thrombocytopenic purpura(ITP) in children. Methods Analysis the clinical data of 255 cases of ITP. Results ①The middle age of 255 cases was 31 months old, and the male vs. female was 1.43:1, 91.37% of patients belonged to acute type, 8.63% were chronic. ②Predisposing factor could be found in 79.60% of cases, and 47.84% of them were infections, 31.76% of onset after vaccinations. ③The pathogens were determined in 73.81% of 168 cases. Human parvovirtus B19(HPVB19), Mycoplasma and EBV were 45.24%, 11.90% and 13.10% in the patients, respectively. ④Among the vaccination associated with ITP, HBV and whooping-cough/diphtheria/tetanus vaccine were 34.57% and 24.69%, respectively. ⑤Bleeding under the skin and mucous membrane was the most Common clinic feature of the patients. but severe bleeding was 5.88% of cases. ⑥There were 56.47% patients whose Platelet counts were bellow to 20×109/L. ⑦Megakaryocytic number in bone marrow were increased in 77.06% of 170 cases. ⑧Complete recovery of the platelet count in 97.42% of patients within two weeks after corticoid or IVIg therapy. Conclusion ① most of ITP in childhood were acute type. ②Viral infections were associated with the disease, especially HPV B19. ③Vaccination associated ITP was not uncommon. ④Corticoid and IVIg therapy had a good effect in treatment of ITP.