Clinical Studies For Hospitalized Childhood Newly Diagnosed Immune Thrombocytopenia Treated With ITP2010Protocol

Objective To explore the clinical curative effects and possibleinfluence factors of hospitalized childhood newly diagnosed immunethrombocytopenia treated with ITP2010protocol. And to provide clinicaldata and references for further optimizing the ITP clinical pathway andestimating prognosis.Methods According to clinical pathway guidelines, combined withcurrent diagnosis and treatment of childhood ITP, the clinical pathway forITP2010protocol was established. Clinical features of total430patientswith newly diagnosed immune thrombocytopenia hospitalized treated with2010protocol during April,2011to April,2013were reviewed andanalyzed. Influence factors statistics were made by using SPSS.Results1.430newly ITP children were enrolled, with the sex ratio of male tofemal was1.72:1and the median age of16.5months. The percentage ofpatients diagnosed in spring, summer, autumn and winter was29.8%,26.3%,21.9%and22.1%, respectively.361cases had a history of infectionbefore the onset, of which respiratory tract infection accounted for82%.28 patients (6.5%) received vaccination before the onset. The time from onsetto treatment was1day to90days. The median platelet count was9×109/L（0～52×109/L）and142patients (33%)with hemorrhagic anemia(mainlymild anemia). Megakaryocytes were increased significantly in91.8%of390cases who underwent bone marrow puncture, which is mainly naiveand particle type, while platelet-producing megakaryocytes rare.404patients underwent pathologic examination,82.4%obtained positiveresults.280cases were treated with glucocorticoid、3cases with gammaglobulin、122cases with glucocorticoid plus gamma globulin and25caseswith symptomatic treatment.2.The recent curative effect: The seventh day of treatment, CR wasachieved in326patients(75.8%) and R in97patients (22.6%). Overallresponse was achieved in403/430(98.4%).The long-term curative effect:308cases were follow-up, the median time to follow-up time was1month,overall response was achieved in67.5%,87.7%,95.1%and98.4%atone,three,six and twelve months follow-up points.11.7%(36/308)patientsrelapsed and1.6%(5/308) patients with chronic course of the disease.2cases died.3.The results of single factor analysis indicated that the age,the timefrom onset to treatment,the time of platelet recovery to normal were relatedto the curative effect of ITP;The results of Logistic regression analysisindicated that the time of platelet recovery to normal was the independent risk factor.Conclusion ITP2010protocol is an effective treatment scheme forchildhood ITP, it can rapidly enhance the platelets level to safety,preventthe occurrence of serious bleeding,reduce the recurrence rate and mortality.The time of platelet recovery to normal was the independent risk factor forthe curative effect of ITP,children who with shorter time of plateletrecovery to normal is with better prognosis.