【摘要】：目的:根據(jù)目前國內(nèi)外關于免疫性血小板減少癥(immune thrombocytopenia,ITP)的診療建議,通過總結我院94例新診斷ITP患兒的相關病歷資料,分析新診斷ITP患兒的臨床特征,為制定更好的臨床診治策略提供依據(jù)。方法:查閱2014年01月至2016年12月于大連醫(yī)科大學附屬第二醫(yī)院兒科收治的94份資料完整的新診斷ITP患兒臨床資料,記錄其臨床特征等相關數(shù)據(jù)。運用統(tǒng)計學軟件對患兒性別、年齡、起病時間、誘因、臨床表現(xiàn)、初診血小板計數(shù)、骨髓細胞學結果、治療前后的血小板參數(shù)等數(shù)據(jù)進行統(tǒng)計學描述和分析。結果:1、本研究中患兒男:女比例為1:1.14;0~3歲嬰幼兒占46.81%,3歲前男孩的患病率大于7歲后(P=0.003)、7歲前女孩的發(fā)病率低于7歲以后(P=0.020);發(fā)病時間在春、夏、秋、冬四季分別占34.04%、34.04%、17.02%、14.90%(P=0.001)。2、有82例患兒起病前有誘因,感染者70例(85.36%),其中上呼吸道感染者占71.43%(n=50);嬰兒、幼兒、學齡前和7~14歲四個年齡段以感染為誘因的概率無明顯差別(P=0.164);嬰幼兒組EB病毒及肺炎支原體感染率低于3歲以上兒童組,差異有統(tǒng)計學意義(P=0.045、P=0.684)。3、本研究中患兒以輕度出血(56.82%)及極重度血小板減少(44.68%)多見,血小板計數(shù)在不同出血程度之間的差別無統(tǒng)計學意義(P=0.789)。4、在于我院行骨髓細胞學檢查的75例患兒中,以骨髓巨核細胞數(shù)增多者為主(n=64),不同類型的巨核細胞以原始幼稚型和顆粒型所占比例偏高,分別為11.43%和67.47%。5、不同血小板計數(shù)之間巨核細胞數(shù)目差異無統(tǒng)計學意義(P0.05),而產(chǎn)板型巨核細胞數(shù)之間差異有統(tǒng)計學意義(P0.05)。6、治療前后的5項血小板參數(shù)指標的差異均有統(tǒng)計學意義(P0.05)。結論:1、兒童新診斷ITP在3歲前男孩多發(fā),而7歲以后則女孩多見;春、夏季多發(fā)。2、感染是兒童新診斷ITP最常見的誘因,各年齡段患兒以感染為誘因的概率無明顯差別;EB病毒、肺炎支原體感染可能是3歲以上兒童ITP發(fā)病的誘因。3、不同出血程度之間的血小板計數(shù)無明顯差別,治療上應更重視臨床表現(xiàn)而非血小板計數(shù)。4、ITP患兒骨髓細胞學檢查結果以巨核細胞數(shù)目增多為主,其中原始幼稚型及顆粒型巨核細胞升高多見。5、不同血小板計數(shù)間巨核細胞數(shù)目無明顯差異,血小板計數(shù)越低,產(chǎn)板型巨核細胞數(shù)目越少。6、ITP患兒血小板參數(shù)在治療前后的改變明顯,與治療前相比,PLT、PCT升高明顯。
[Abstract]:Objective: according to the suggestions of diagnosis and treatment of immune thrombocytopenia at home and abroad, the clinical features of 94 newly diagnosed children in our hospital were analyzed. To provide the basis for making better clinical diagnosis and treatment strategy. Methods: from January 2014 to December 2016, 94 newly diagnosed children with ITP were collected from pediatrics department of the second affiliated Hospital of Dalian Medical University and their clinical data were recorded. The data of sex, age, onset time, inducement, clinical manifestation, platelet count at first visit, bone marrow cytology, platelet parameters before and after treatment were described and analyzed by statistical software. Results in this study, the ratio of male to female was 1: 1.140.The prevalence rate of boys before 3 years old was higher than that after 7 years old (P0. 003) and the incidence rate of girls before 7 years old was lower than that after 7 years old (P0. 020), and the onset time was in spring, summer, autumn, and in spring, summer and autumn, the incidence rate of children before 7 years old was lower than that after 7 years old (P0. 020). The four seasons in winter accounted for 14.90% (P0. 001) and 14.90% (P < 0. 001), respectively. There were 82 cases with inducement, 70 cases (85. 36%) infected with infection, 71.43% (n = 50) of upper respiratory tract infection, There was no significant difference in the probability of infection as an inducement between preschool and 7- and 14-year-olds (P0. 164), and the infection rates of Epstein-Barr virus and Mycoplasma pneumoniae in infants and infants were lower than those in children over 3 years of age. The difference was statistically significant (P0. 045 / P0. 684). 3. Mild hemorrhage (56.82%) and extremely severe thrombocytopenia (44.68%) were more common in this study. There was no significant difference in platelet count between different bleeding degrees (P0. 789). The number of bone marrow megakaryocytes increased mainly (nnm64), and the proportion of different types of megakaryocytes was higher than that of primitive type and granular type. The number of megakaryocyte in different platelet count had no significant difference (P0.05), while the number of plate-producing megakaryocyte was significantly different (P0.05). There were significant differences in 5 platelet parameters before and after treatment (P0.05). ConclusionTwo one, children with newly diagnosed ITP were more common in boys before 3 years old than in girls after 7 years of age, infection was the most common inducement of new diagnosis of ITP in children in spring and summer, and there was no significant difference in the probability of infection as inducement of EBV in children of all ages. Mycoplasma pneumoniae infection may be the cause of ITP in children over 3 years old. There is no significant difference in platelet count among different bleeding degrees. In treatment, more attention should be paid to clinical manifestations rather than to platelet count. The results of bone marrow cytology in children with ITP were mainly the increase of megakaryocyte number. The number of megakaryocytes in primitive immature type and granulosa type was higher than that in primitive type. 5. There was no significant difference in the number of megakaryocytes among different platelet counts, and the lower the platelet count, the lower the number of megakaryocytes. The smaller the number of platelet-producing megakaryocytes, the more significant changes of platelet parameters were before and after treatment, and the increase of PLT PCT was significant compared with that before treatment.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R725.5

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