| Objectives To Analyze the clinical characteristics of childhood immunethrombocytopenic purpura (ITP); evaluate the clinical efficacy of different treatmentmeasures; investigate the possible risk factors to the development of children acute idiopathicthrombocytopenic purpura (AITP) into chronic idiopathic thrombocytopenic pupura (CITP)and improve the prognosis.Methods Children newly diagnosed with ITP according to the child ITP diagnosticcriteria from November2001to September2011admitted in the General Hospital of NingxiaMedical University were enrolled in the study. Their data were analyzed using statisticalsoftware.Results Totally636cases were enrolled, with the average age of55.4months (range1month～15years) and the male to female ratio1.35:1. The percentage of patients in spring,summer, autumn and winter was21.70%,36.01%,19.18%and23.11%, respectively.310cases (48.74%) had a history of infection before the onset, of which upper respiratory tractinfection accounted for74.19%.103patients underwent pathologic examination, of whom70cases (67.96%) obtained positive results.191patients (30.03%) received vaccination beforethe onset. The patients were divided into the following groups:<1year,1～years,3～years,7～years and10～years, with the incidence rates27.04%,19.97%,29.40%,12.42%and11.16%, respectively. There was no statistically significant difference in gender in each agegroup, while the proportion of girls increased significantly to64.79%in10～years group.Megakaryocytes (MK) were in normal range in23.25%of456cases who underwent bonemarrow puncture. In3/4of the remaining cases with MK increased significantly, which ismainly naive and particle type, while platelet-producing MK decreased or even absent. Wilcoxon test was used for statistical analysis of the efficacy of each age group, there wasstatistically significant differenceonly in treatment efficacy between various age groups and3～years’ group. Logistic regression multi-factor analysis showed that glucocorticoid plusgamma globulin treatment, course of disease, supportive treatment, age, time of plateletincreasing to normal range, number of particle MK are independent risk factors to thedevelopment of children AITP into CITP.Conclusion1. AITP is more common in children, with the peak season winter andsummer. Patients usually have a history of infection or vaccination before the onset. Theincidence is higher in boy,<1year’s and3～7years’ group.2. Skin and mucous membranebleeding is main clinical manifestations, while serious life threatening bleeding is rare.3.Bone marrow cytology shows increased megakaryocytes, usually accompany with maturationarrest, mainly with increased original naive and particle type and decreased or even absentplatelet～producing megakaryocyte.4. Proper treatment should be chosen according to thepatient’s condition, inorder to control the disease and improve PLT.5. Glucocorticoid, IVIGis commonly used first line treatment for ITP of children and most children have a goodresponse.6. Children ITP with a history of infection and positive pathogen have good effect,while older children have a poorer treatment response.7. Glucocorticoid plus gamma globulintreatment, course of disease, supportive treatment, age, time of platelet increase to normalrange, number of particle MK are independent risk factors to the development of childrenAITP into CITP. |
