本文選題：兒童 + 免疫性血小板減少性紫癜�。� 參考：《寧夏醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的分析兒童免疫性血小板減少性紫癜（immune thrombocytopenic purpura，ITP）患者的臨床特點(diǎn)；評(píng)價(jià)臨床常用不同治療方法的療效；探討影響ITP患兒由急性免疫性血小板減少性紫癜（AITP）發(fā)展為慢性免疫性血小板減少性紫癜（CITP）的可能相關(guān)因素，改善ITP患兒的預(yù)后。 方法收集2001年11月至2011年9月在寧夏醫(yī)科大學(xué)附屬總院初診為ITP的兒童為研究對(duì)象，整理相關(guān)數(shù)據(jù)，并運(yùn)用統(tǒng)計(jì)軟件進(jìn)行分析。 結(jié)果共收集病例636例，男/女為1.35：1。患兒年齡介于1月～15歲，平均年齡為55.4月，均符合兒童ITP診斷標(biāo)準(zhǔn)。春、夏、秋、冬季發(fā)病所占比例為21.70%、36.01%、19.18%、23.11%。310例發(fā)病1～4周前有感染病史，占48.74%，其中上呼吸道感染230例，占74.19%。103例患兒行病原學(xué)檢查，70例陽性，陽性率為67.96%。191例患兒發(fā)病前有預(yù)防接種史，占30.03%。病例分為1歲組、1～歲組、3～歲組、7～歲組及10～歲組，比例分別為27.04%、19.97%、29.40%、12.42%、11.16%，各年齡組男、女性別差異無統(tǒng)計(jì)學(xué)意義，但是10～歲組中女孩比例明顯增加，為64.79%。456例患兒行骨髓細(xì)胞學(xué)（BM）檢查，23.25%巨核細(xì)胞（MK）總數(shù)正常，其余患兒中約3/4的MK明顯增高，以原始幼稚型和顆粒型MK為主，，而產(chǎn)血小板型少見甚至缺如。采用秩和檢驗(yàn)對(duì)各年齡組療效進(jìn)行統(tǒng)計(jì)分析，各年齡組療效差異有統(tǒng)計(jì)學(xué)意義，同時(shí)僅3～歲組內(nèi)不同治療方法療效差異有統(tǒng)計(jì)學(xué)意義。利用Logistic回歸模型多因素分析，提示糖皮質(zhì)激素+IVIG聯(lián)合治療、病程、對(duì)癥支持治療、年齡、血小板上升正常時(shí)間及顆粒型MK可作為兒童AITP轉(zhuǎn)為CITP的獨(dú)立危險(xiǎn)因素。 結(jié)論1.兒童ITP以AITP多見，多發(fā)于冬季、夏季，多有感染及疫苗接種史，男孩發(fā)病數(shù)較女孩高，小于1歲及3～7歲的兒童多發(fā)。2.臨床表現(xiàn)以皮膚黏膜出血為主，嚴(yán)重的危及生命的出血少見。3.BM檢查以MK增多為主，多伴有成熟障礙，其中原始幼稚型及顆粒型MK升高多見，產(chǎn)板型MK減低甚至缺如。4.需依據(jù)患兒病情擬定治療方案，及時(shí)控制病情并提升PLT。5.糖皮質(zhì)激素和IVIG為兒童ITP的常用一線治療，多數(shù)患兒療效較好。6.有明確感染史及病原學(xué)檢查陽性的患兒療效較好，年齡大患兒療效較差。7.糖皮質(zhì)激素+IVIG聯(lián)合治療、病程、對(duì)癥支持治療、年齡、血小板上升至正常時(shí)間及顆粒型MK可作為兒童AITP轉(zhuǎn)為CITP的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to analyze the clinical characteristics of children with immune thrombocytopenic purpura (immune thrombocytopenic purpura), and to evaluate the efficacy of different treatment methods. To explore the possible factors influencing the development from acute immune thrombocytopenic purpura (AITP) to chronic immune thrombocytopenic purpura (CITP) in children with ITP, and to improve the prognosis of children with ITP. Methods Children who were newly diagnosed as ITP in affiliated General Hospital of Ningxia Medical University from November 2001 to September 2011 were collected and analyzed by statistical software. Results 636 cases were collected, male / female was 1.35: 1. The age of the children ranged from 15 to 15 years old in January, and the average age was 55.4 months. All the children were in accordance with the diagnostic criteria of ITP in children. The incidence rate in spring, summer, autumn and winter was 21.700.36.01and 19.18. 310 cases had a history of infection 4 weeks before onset, accounting for 48.74. of them, 230 cases were upper respiratory tract infection, 70 cases were positive for etiology examination, and the positive rate was 67.96.191 cases had history of prophylactic inoculation before onset. 30.03%. The cases were divided into 1 year old group, 1 year old group, 3 ~ year old group, 7 ~ year old group and 10 ~ year old group, the proportion of them were 27.04, 19.97 and 29.40 respectively. There was no significant difference between male and female in each age group, but the proportion of girls in 10 ~ year old group increased obviously. Bone marrow cytology (BM) examination showed that the total number of megakaryocytes (MK) was normal in 64.79 and 456 children. About 3 / 4 of MK in other children were significantly increased, mainly in primitive infantile type and granular type, but platelet-producing type was rare or absent. Rank sum test was used to analyze the curative effect of each age group. The difference of curative effect was statistically significant in each age group, and there was statistical significance only in 3 ~ year old group. The multivariate analysis of logistic regression model suggested that the combination of glucocorticoid IVIG therapy, course of disease, symptomatic support therapy, age, normal time of platelet rise and granular MK could be independent risk factors for the conversion of AITP to CITP in children. Conclusion 1. AITP was more common in children, mostly in winter and summer, and had more history of infection and vaccination. The incidence of ITP in boys was higher than that in girls, and it was more common in children younger than 1 year old and 3 ~ 7 years old. The clinical manifestations were mainly skin and mucosal hemorrhage, and the severe life-threatening hemorrhage was rare. 3. The increase of MK was main in BM examination, and most of them were accompanied with mature disorder. Among them, the increase of MK in primitive infantile type and granular type, and the decrease or even absence of MK in plate-producing type. According to the condition of the child, the treatment plan should be drawn up, and the disease should be controlled and PLT.5. Glucocorticoid and IVIG are common first line treatment of ITP in children. Children with definite history of infection and positive etiological examination had better curative effect, while the older children had a poor curative effect. 7. 7. Combined therapy of glucocorticoid IVIG, course of disease, treatment of symptomatic support, age, time of platelet rise to normal and granular MK may be the independent risk factors for the conversion of AITP to CITP in children.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李春;潘家華;劉洪軍;沈f

本文編號(hào)：2082852