【摘要】：目的:探討兒童原發(fā)性免疫性血小板減少癥(immune thrombocytopenic purpura,ITP)慢性轉(zhuǎn)化的的危險因素。方法:選擇2014年1月至2016年1月在青大附院血液兒科初診住院的原發(fā)性免疫性血小板減少癥患兒進行隨訪,將有效隨訪大于1年的患兒為研究對象,分為非慢性組和慢性組。采用回顧性分析方法對有效隨訪的原發(fā)性免疫性血小板減少癥患兒的臨床資料進行統(tǒng)計處理,分析非慢性原發(fā)性免疫性血小板減少癥(non-chronic immune thrombocytopenic purpura,NCITP)與慢性原發(fā)性免疫性血小板減少癥(chronic immune thrombocytopenic purpura,CITP)在發(fā)病年齡、性別、可能感染的誘因、初診時病程、初診時血小板計數(shù)、初診時淋巴細(xì)胞絕對數(shù)、調(diào)節(jié)性淋巴細(xì)胞亞群、骨髓巨核細(xì)胞方面有無差異。結(jié)果:共收集有效隨訪病例183例,男105例,女78例。年齡在1個月至13歲1個月之間,中位年齡3歲6個月。CITP患兒48例,占26.2%;NCITP患兒135例,占73.8%。CITP組中大于3歲發(fā)病的患兒比例大于NCITP組,分別占77.1%和56.3%,兩組間差異有統(tǒng)計學(xué)意義(χ2=6.476,P=0.011);CITP組初診時病程大于NCITP組[(5±3.53)天對(3.56±3.06)天,t=-2.696,P=0.008];CITP組初診時血小板計數(shù)低于NCITP組[(22.15±16.26)×109/l對(31.61±22.21)×109/l,t=2.703,p=0.008];CITP組中骨髓巨核細(xì)胞總數(shù)≥100個的患兒比例大于NCITP組,分別為81.2%和61.5%,兩組間差異有統(tǒng)計學(xué)意義(χ2=6.227,P=0.013);CITP組初診時淋巴細(xì)胞絕對數(shù)小于NCITP組[(2.88±1.06)×109/l對(4.07±2.23)×109/l,t=3.550,P=0.000];CITP組外周血中調(diào)節(jié)T細(xì)胞的百分比低于NCITP組[(2.50±1.32)%對(3.27±1.60)%,t=2.396,P=0.019];CITP組CD4+T輔助細(xì)胞百分比低于NCITP組[(31.58±8.39)%對(34.66±8.81)%,t=2.112,P=0.036];CITP組CD4/CD8T細(xì)胞比值低于NCITP組[(1.28±1.60)對(1.56±0.68)%,t=2.55,P=0.012]。兩組間外周血CD8+T抑制細(xì)胞、CD19B細(xì)胞、NK細(xì)胞、活化T細(xì)胞、活化B細(xì)胞、性別、可能感染誘因、骨髓巨核細(xì)胞分化類型比例無統(tǒng)計學(xué)差異。對有意義的因素行非條件logistic回歸分析,初診時病程的回歸系數(shù)為0.252,wald檢驗結(jié)果P=0.009,有統(tǒng)計學(xué)差異,OR值為1.287;初診時淋巴細(xì)胞絕對數(shù)的回歸系數(shù)為-0.556,wald檢驗結(jié)果P=0.005,有統(tǒng)計學(xué)差異,OR值為0.573;調(diào)節(jié)T細(xì)胞比例的回歸系數(shù)為-0.545,wald檢驗結(jié)果P=0.018,有統(tǒng)計學(xué)差異,OR值為0.580。對以上3個獨立危險因素行ROC分析確定其臨界值,初診時淋巴細(xì)胞絕對數(shù)為3.03×109/l,敏感度為64.6%,特異度為60.7%;調(diào)節(jié)T細(xì)胞比例為2.03%,敏感度為78.9%,特異度為51.5%;初診時病程為3.5天,敏感度為54.2%,特異度為65.9%。結(jié)論:1.慢性ITP大于3歲發(fā)病的患兒比例大于非慢性ITP患兒,慢性ITP患兒初診時病程大于非慢性ITP患兒,慢性ITP患兒初診時淋巴細(xì)胞絕對數(shù)小于非慢性患兒,慢性ITP患兒調(diào)節(jié)T細(xì)胞比例小于非慢性ITP患兒,慢性ITP患兒CD4/CD8比值小于非慢性ITP患兒。2.初診時病程、初診時淋巴細(xì)胞絕對數(shù)、調(diào)節(jié)T細(xì)胞比例為兒童ITP慢性化的獨立危險因素。
[Abstract]:Objective: to investigate the risk factors of chronic transformation in children with primary immune thrombocytopenia (immune thrombocytopenic purpura,ITP). Methods: from January 2014 to January 2016, the children with primary immune thrombocytopenia were followed up in the Department of Hematology, affiliated Hospital of Youth University. The children with effective follow-up for more than 1 year were divided into non-chronic group and chronic group. The clinical data of children with primary immune thrombocytopenia were statistically analyzed by retrospective analysis, and the non-chronic primary immune thrombocytopenia (non-chronic immune thrombocytopenic purpura,) was analyzed. NCITP) and (chronic immune thrombocytopenic purpura,CITP) in the age of onset, sex, the inducement of possible infection, the course of first diagnosis, platelet count at first diagnosis, absolute number of lymphocytes at first diagnosis, There were no differences in regulatory lymphocyte subsets and megakaryocytes in bone marrow. Results: 183 cases, 105 males and 78 females, were collected. Between 1 month and 13 years old and 1 month old, the median age was 3 years and 6 months. There were 48 children with CITP, accounting for 26.2%. There were 135 children with NCITP, the proportion of children over 3 years old in 73.8%.CITP group was higher than that in NCITP group (77.1% and 56.3%, respectively). There was significant difference between the two groups (蠂 2 鈮，

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