儿童原发性免疫性血小板减少症慢性化的危险因素分析

Analysis of risk factors for chronicity in childhood primary immune thrombocytopenia

摘要

目的 探讨儿童原发性免疫性血小板减少症(ITP)慢性化的危险因素,为儿童慢性ITP(cITP)的早发现及干预提供依据。方法 回顾性分析2019年1月至2022年3月收住于蚌埠医科大学第一附属医院儿科血液肿瘤组确诊并随访12个月以上的214例ITP患儿的临床资料.将患儿按照发病年龄分为≤10岁组(188例)与>10岁组(26例).根据ITP患儿是否转化为cITP将其分为非慢性ITP组(181例)与cITP组(33例).根据患儿年龄将其分为≤1岁组(52例)、1~≤3岁组(54例)、3~≤6岁组(63例)、6~≤10岁组(19例)、>10岁组(26例).通过单因素和多因素Logistic回归分析影响ITP患儿慢性化的危险因素。结果 在214例ITP患儿中,cITP为33例(15.42%),非慢性ITP为181例(84.58%).非慢性ITP组与cITP组患儿年龄、前驱诱因、起病情况的分布比较,差异均有统计学意义(χ²值分别为65.704、3.906、116.626,P<0.05).ITP患儿出血症状评分与血小板计数之间呈明显负相关(r=-0.261,P=0.001).非慢性ITP组与cITP组患儿的绝对淋巴细胞计数(ALC)、血小板计数比较,差异均有统计学意义(Z值分别为-6.134、-3.220,P<0.05).多因素Logistic回归分析结果显示:年龄>10岁、隐匿起病是患儿发生cITP的危险因素(OR值分别为6.533、57.978,P<0.05),高水平ALC是患儿发生cITP的保护因素(OR=0.406,P<0.05)。结论 年龄>10岁、隐匿起病、ALC低均是cITP患儿的危险因素.

Abstract

Objective To investigate the risk factors for chronicity in childhood primary immune thrombocytopenia (ITP) and provide a basis for early identification and intervention of chronic ITP (cITP) in children. Methods A retrospective analysis was conducted on the clinical data of 214 children diagnosed with ITP and followed for more than 12 months, who were admitted to the Pediatric Hematology-Oncology Department of the First Affiliated Hospital of Bengbu Medical College from January 2019 to March 2022. Based on age at onset, patients were divided into two groups: ≤10 years old (188 cases) and >10 years old (26 cases). According to whether the ITP progressed to chronicity, patients were categorized into a non-chronic ITP group (181 cases) and a chronic ITP (cITP) group (33 cases). Additionally, patients were grouped by age: ≤1 year (52 cases), 1-≤3 years (54 cases), 3-≤6 years (63 cases), 6-≤10 years (19 cases), and >10 years (26 cases). Univariate and multivariate logistic regression analyses were used to identify risk factors for the chronicity of ITP. Results Among the 214 children with ITP, 33 cases (15.42%) developed cITP, while 181 cases (84.58%) remained non-chronic ITP. Significant differences were observed between the non-chronic ITP and cITP groups in terms of age, presence of preceding triggers, and onset pattern (χ²=65.704, 3.906 and 116.626, respectively, P<0.05). A significant negative correlation was found between bleeding symptom scores and platelet count (r=-0.261, P=0.001). The absolute lymphocyte count (ALC) and platelet count also differed significantly between the two groups (Z=-6.134 and -3.220, respectively, P<0.05). Multivariate logistic regression analysis showed that age >10 years (OR=6.533) and insidious onset (OR=57.978) were risk factors for developing cITP (P<0.05), while high ALC levels were a protective factor (OR=0.406, P<0.05). Conclusion Age >10 years, insidious onset, and low ALC are all risk factors for the development of chronic ITP in children.

关键词

原发性免疫性血小板减少症 / 慢性化 / 儿童 / 出血症状评分 / 外周血淋巴细胞亚群 / 体液免疫

Key words

primary immune thrombocytopenia / chronicity / child / bleeding symptom score / peripheral blood lymphocyte subsets / humoral immunity

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基金资助

蚌埠医学院自然科学重点项目(2021byzd176)