| Part1 Analysis of clinical features of newly diagnosed ITP in childrenObjectsThe clinical data of 201 patients with newly diagnosed Immune thrombocytopenia(ITP)hospitalized in Qilu Hospital of Shandong University were analyzed retrospectively,the clinical features of the disease were summarized,and the clinical significance of the abnormal bone marrow megakaryocytes(MK)in newly diagnosed children with ITP and its relationship with prognosis were discussed.MethodsA total of 630 children with ITP were searched in Qilu Hospital of Shandong University from January 2015 to June 2021.201 children with newly diagnosed ITP were selected by inclusion criteria and excluded from incomplete clinical data.They were followed up for at least one year by searching electronic medical records,outpatient service or telephone.The age,sex,initial course of disease,inducement,bleeding,auxiliary examination,total course of disease,treatment plan and initial reaction were statistically analyzed.The clinical characteristics of children with ITP in high MK group,normal MK group and low MK group were analyzed by nonparametric test,and the relationship between bone marrow MK abnormality and prognosis in newly diagnosed ITP children was discussed.Results1.A total of 201 newly diagnosed children with ITP were included in this study.It was found that the age of onset ranged from 3 days to 16 years old,and the median age of onset was 2 years and 10 months(34 months).The peak age of onset of ITP was 0-3 years old.Among the children,there were 116 males(57.71%)and 85 females(42.29%).The overall male-to-female ratio was 1.36:1,but there was no statistical difference among different age groups.The time of first onset in spring,summer,autumn and winter accounted for 28.36%,32.84%,14.93%and 23.88%respectively,with the peak in spring and summer.2.The inducement of onset was clear in 138 cases(68.66%),including 122 cases of infection(60.70%)and 16 cases of vaccination(7.96%).Upper respiratory tract infection was the main infection(74 cases,37.31%),followed by bronchopneumonia(24 cases,11.94%).The pathogens were Epstein Barr virus(EBV)infection(n=39),Mycoplasma Pneumoniae(MP)infection(n=26),Cytomegalovirus(CMV)infection(n=1),Helicobacter pylori(HP)(n=1),streptococci(n=1)and influenza virus(n=1).179 children(89.05%)with ITP had skin hemorrhage,including 53 cases of mucosal hemorrhage(33 cases of oral mucosal hemorrhage,18 cases of nasal mucosal hemorrhage,2 cases of bulbar conjunctival hemorrhage),11 cases of visceral hemorrhage(2 cases of intracranial hemorrhage,4 cases of urinary bleeding,5 cases of gastrointestinal bleeding)and 22 cases without any bleeding.The median bleeding score of the children was 2.3.Among the 201 cases,153 cases(76.11%)achieved complete remission within 1 year after diagnosis,48 cases(23.88%)progressed to chronic ITP.There was no significant difference in the chronic rate of disease course among different treatment groups(P>0.05).The days required to achieve partial response(PR)and complete response(CR)were statistically significant among different treatment groups(P<0.05).Among the children who were given drug treatment,the time required to reach PR and CR was the longest in the children treated with glucocorticoid alone.4.Bone marrow cytological smears showed that the number of megakaryocytes increased(>35/4.5cm2)(185 cases,92.04%).The proportion of naive and granular megakaryocytes in different stages was 51.78%and 37.16%,respectively.The patients were divided into three groups according to the number of megakaryocytes from high to low.The results showed that there were significant differences in bleeding score,naive megakaryocytes,platelet-producing megakaryocytes,naked nucleus megakaryocytes,persistent response rate and total course of disease among the three groups(P<0.05).Conclusion1.The peak age of ITP onset was concentrated in infancy,and there was no difference in the ratio of male to female among different age groups.2.The onset season is more common in spring and summer.More than half of the children with ITP had predisposing factors;Epstein-barr virus and mycoplasma pneumoniae infection are important causes of ITP.Most of the children with ITP were skin bleeding,and a few were accompanied by mucosal bleeding.3.Most children with ITP can get CR within one year,and those who are treated with glucocorticoid alone need the longest time to obtain PR and CR.4.Bone marrow cytological smears of children with TP showed that the number of megakaryocytes increased mainly,and the increase of naive and granular megakaryocytes was the most common.The bleeding score,continuous response rate and total course of disease were related to the number of megakaryocytes.Part2 Analysis of influencing factors of chronic course of ITP in childrenObjectsTo explore the influencing factors of chronic course of immune thrombocytopenia(ITP)in children,and to provide basis for clinical judgment of the outcome of the disease,so as to make early diagnosis and timely intervention of chronic ITP in children.MethodsThe clinical data of newly diagnosed children with ITP who were hospitalized in Qilu Hospital of Shandong University from January 2015 to June 2021 were included.The patients were followed up for at least one year by searching electronic medical records,outpatient service or telephone.According to the total course of disease,the subjects were divided into chronic ITP group(total course>12 months)and non-chronic ITP group(total course≤ 12 months).Rank sum test and chi-square test were used to compare the differences between the two groups.Univariate Logistic regression was used to analyze the statistically significant influencing factors between the two groups.Multivariate Logistic regression analysis was conducted to screen out the independent influencing factors related to chronic ITP.The receiver working characteristic curve(ROC)was used to find the best cut-off point of independent influencing factors to evaluate its prognostic value in the outcome of children with ITP.Results1.In this study,a total of 201 newly diagnosed children with ITP were divided into two groups according to the total course of disease,including 153 chronic ITP(76.12%)and 48 chronic ITP(23.88%).In the chronic ITP group,the age of first onset was older,the course of initial diagnosis was longer,the rate of sustained response was lower than those in the non-chronic ITP group(P<0.05).2.Univariate analysis showed that the age of first onset,the inducement of onset,the course of first diagnosis,the days needed to reach PR after treatment,the days needed to reach CR and no sustained response after treatment were related to the chronic course of ITP(P<0.2).3.The results of multivariate analysis showed that older age of first onset,no continuous response and short maintenance time after reaching CR were independent risk factors for chronic course of ITP in children(P<0.05).The analysis of receiver operating characteristic curve showed that the area under the ROC curve of maintenance time after reaching CR was the largest,which was 0.933(95%CI,0.901-0.966),followed by the failure to obtain sustained response and age.Conclusion1.Among the 201 children with ITP,most of them were cured within 12 months.and the children with older age of first onset,long course of first diagnosis and low persistent response rate were likely to develop into chronic ITP.2.Older age of first onset,lack of continuous response and short maintenance time after reaching CR are independent risk factors for chronic course of ITP in children.The order of the ability to predict the chronic course of ITP in children from large to small is the maintenance time after CR,lack of continuous response and the age of first onset. |
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