發(fā)布時(shí)間：2018-09-09 16:17

【摘要】：目的:分析兒童免疫性血小板減少癥(immune thrombocytopenia,ITP)臨床特征及療效,分析中性粒細(xì)胞與淋巴細(xì)胞比值(neutrophil to lymphocyte ratio,NLR)在兒童ITP的診斷價(jià)值。方法:收集2006年1月至2016年10月間在本院兒科住院治療的共112例ITP病例,分析臨床特征。將中度以上血小板減少的患兒分為丙種球蛋白低劑量(1.2g/kg)和高劑量組(2g/kg),兩組均給予地塞米松聯(lián)合治療,分析其療效。以同年齡段正常兒童的NLR作為對(duì)照組,分析入院時(shí)NLR對(duì)兒童ITP的診斷價(jià)值。結(jié)果:112例ITP患兒年齡在1月～14歲,平均年齡為42.4月,發(fā)病年齡5歲占76.8%,各年齡組男、女性別無(wú)明顯統(tǒng)計(jì)學(xué)差異。春、冬季節(jié)發(fā)病率較夏、秋季節(jié)高(P0.05)。79例(70.5%)初診血小板計(jì)數(shù)30×109/L。46例(41%)發(fā)病前1～3周有急性感染病史,其中上呼吸道感染42例(37.5%),腸道感染4例(3.5%);11例(9.82%)發(fā)病前有疫苗接種史。皮膚淤點(diǎn)淤斑108例(96.4%),口腔黏膜出血25例(22.3%),鼻出血8例(7.1%),牙齦出血4例(3.5%),眼結(jié)膜出血和便血各2例(1.8%),血尿1例(0.9%)。兩組治療后血小板計(jì)數(shù)與治療前相比均有明顯統(tǒng)計(jì)學(xué)差異,兩組療效無(wú)明顯統(tǒng)計(jì)學(xué)差異。入院時(shí)ITP患兒NLR(0.75±0.59)和正常組兒童NLR(0.76±0.36)比較無(wú)明顯統(tǒng)計(jì)學(xué)差異。結(jié)論:1.兒童ITP多發(fā)于春、冬季,發(fā)病前多有上呼吸道感染史,男女發(fā)病率無(wú)明顯差異,5歲以內(nèi)兒童多發(fā)。2.多數(shù)ITP患兒發(fā)病時(shí)血小板計(jì)數(shù)30×109/L,臨床表現(xiàn)以皮膚黏膜出血為主。3.采用低劑量和高劑量丙種球蛋白治療兒童ITP的短期療效無(wú)明顯差異。4.入院時(shí)NLR對(duì)兒童ITP的診斷無(wú)參考意義。
[Abstract]:Objective: to analyze the clinical characteristics and curative effect of immune thrombocytopenia (immune thrombocytopenia,ITP) in children, and to analyze the diagnostic value of neutrophil to lymphocyte ratio (neutrophil to lymphocyte ratio,NLR) in children with ITP. Methods: 112 cases of ITP were collected from January 2006 to October 2016, and the clinical features were analyzed. Children with moderate thrombocytopenia were divided into two groups: low dose of globulin (1.2g/kg) and high dose group (2g/kg). Both groups were treated with dexamethasone. NLR of normal children of the same age was used as control group to analyze the diagnostic value of NLR in children with ITP at admission. Results one hundred and twelve children with ITP were 14 years old in January, with an average age of 42.4 months. The age of onset was 5 years old (76.8%). There was no significant difference between male and female in all age groups. The incidence in spring and winter was higher than that in summer, and the incidence of acute infection was higher in autumn (P0.05) .79 cases (70.5%) than that in summer. The platelet count of 30 脳 109/L.46 (41%) had a history of acute infection 1 week before onset. 42 cases (37.5%) of upper respiratory tract infection and 11 cases (9.82%) of intestinal infection had a history of vaccination before the onset of the disease, including 42 cases (37.5%) of upper respiratory tract infection, 4 cases (3.5%) of intestinal infection and 11 cases (9.82%) of intestinal infection. There were 108 cases (96.4%) of skin stasis spots, 25 cases (22.3%) of oral mucosal hemorrhage, 8 cases (7.1%) of epistaxis, 4 cases (3.5%) of gingival bleeding, 2 cases (1.8%) of conjunctival hemorrhage and 1 case (0.8%) of hematuria, and 1 case (0.9%) of hematuria. There was significant difference in platelet count between the two groups after treatment, and there was no significant difference in curative effect between the two groups. There was no significant difference in NLR between ITP children (0.75 鹵0.59) and normal children (0.76 鹵0.36) at admission. Conclusion 1. ITP was more common in spring and winter, and had a history of upper respiratory tract infection before onset. There was no significant difference in incidence of ITP between male and female children under 5 years old. The platelet count was 30 脳 10 9 / L in most ITP children, and the clinical manifestations were mainly skin and mucosal hemorrhage. 3. 3. There was no significant difference between low dose gamma globulin and high dose gamma globulin in the treatment of children with ITP. At admission, NLR has no reference value in the diagnosis of ITP in children.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.5

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