Clinical Analysis Of 117 Cases Of Primary Immune Thrombocytopenia

Object:To compare the clinical features and response to different regimens of patients with different types of primary immune thrombocytopenia(ITP).Method:Search the medical records of patients diagnosed ITP in our hospital from January 2012 to December 2016,classify the patients to three different types that newly diagnosed ITP,persistent ITP and chronic ITP according to the consensus of diagnosis and treatment of adult ITP by hemostasis and thrombosis group of the Chinese Medical Association,retrospectively analyzed and compared the differentiation in general information,bleeding score,examination,treatment and curative effect between the three differente clinical types.Result:1.117 cases are included in our study,64 cases of them are newly diagnosed ITP,10 cases are persistent ITP,43 cases are chronic ITP.Proportion of severe ITP in each of the three different stages of ITP is 73.4%,70%,55.8%.2.ITP can occur in all ages,there are no significant difference in age distribution between different stages of ITP,30?50 year old female ratio was significantly higher than that of male,proportion of female patients in chronic ITP was significantly higher than those of newly diagnosed ITP and persistent ITP.3.Most of patients represent with skin bleeding,followed by gum,oral and nasal bleeding,hematochezia,hematuria,menstruation increase or vaginal bleeding can also occur in some patients,there are no significant difference between the bleeding site of different stages of ITP.4.Bleeding score was negatively correlated with platelet count,and was positively correlated with age.There are same results in newly diagnosed ITP,chronic ITP but no significant correlation in persistent ITP.5.Numbers of bone marrow megakaryocyte in ITP patients are normal or increased,all patients have bone marrow megakaryocyte maturation disorder.6.19 cases of ITP patients with peripheral blood lymphocyte subsets were normal,in those abnormal results,CD3+CD4+T lymphocytes decreased in 3 cases,1 cases of patients elevated,CD3+CD8+T lymphocytes were increased in 3 cases;CD4+/CD8+T lymphocyte ratio in 5 cases were decreased;CD3-CD19+B lymphocyte count was increased in 9 cases;CD3-CD16+CD56+NK lymphocyte count in 9 patients were decreased.There are more patients with abnormal T lymphocyte count and B lymphocyte count in newly diagnosed ITP than those in chronic ITP,while patients with chronic ITP are more likely have low NK cells count than those with newly diagnosed ITP.7.Glucocorticoid combined with immunoglobulin has the shortest onset time for 3 days,followed by single dose glucocorticoid treatment,for 4 days,TPO alone and TPO combined with other treatment onset time were 5.5 days and 6 days,slightly longer than the glucocorticoid containing solution.The effective rate of glucocorticoid was 84.7%,the effective rate of glucocorticoid combined with immunoglobulin was 76.9%,the effective rate of single TPO therapy was 85.7%,and the effective rate of TPO combined therapy was 90%.12 patients of those who resist to glucocorticoid contained regimen,8 were treated with sequential TPO therapy,median effect time was 6.5 day,similar to the therapy of TPO in combination with other medications.9.The effective rate of chronic ITP with single drug glucocorticoid regimen was lower than that of newly diagnosed ITP and persistent ITP,and the onset time of the newly diagnosed ITP was 3 days,the persistent ITP and chronic ITP were 5 days.The median onset time of corticosteroids and immuno globulin in different stages of ITP was 3 days.10.The single drug TPO and TPO combination treatment for different stages of ITP median onset time is similar,about 6 days,TPO combined with other drug regimens for chronic ITP,the effective rate is slightly lower than the newly diagnosed ITP and persistent ITP.The glucocorticoid regimen was ineffective in 12 patients and sequentially treated with TPO,the chronic ITP had the lowest efficacy,but the onset time was similar,about 6 days.Conclusion:1.Newly diagnosed ITP ratio is higher than persistent ITP and chronic ITP,most of them were severe ITP.2.ITP can occur in all ages,there are no significant difference in age distribution between different stages of ITP,30?50 year old female ratio was significantly higher than that of male,proportion of female patients in chronic ITP was significantly higher than those of newly diagnosed ITP and persistent ITP.ITP patients of all ages can be affected,the incidence of women in childbearing age was significantly higher than that of men,the proportion of women with chronic ITP was significantly higher than that of newly diagnosed ITP and persistent ITP.3.Platelet count,age can be used as predictors of bleeding risk.4.Peripheral blood lymphocyte subsets of the different stages of ITP patients showed normal,abnormal patients showed reduced to CD4+T cells,CD8+T lymphocytes increased,CD4+/CD8+ decreased,B lymphocytes increased.In patients with chronic ITP NK cells decreased significantly more than patients with newly diagnosed ITP.5.Glucocorticoid and immunoglobulin regimen had the fastest effect,about 3 days.The single glucocorticoid regimen was followed by about 4 days,and the onset time of TPO treatment was about 6 days.The combined treatment with TPO seems more effective than other treatments.6.Glucocorticoid treatment of chronic ITP is less effective than the new diagnosis of ITP,the onset time is prolonged.Median time to onset of glucocorticoid and immunoglobulin treatment of chronic ITP is similar to the newly diagnosed ITP.7.The efficacy of chronic ITP with TPO regimen was lower than that of newly diagnosed ITP and persistent ITP,but the time of onset was similar.Sequential treatment with TPO and TPO in patients with corticosteroid failure was similar in time of onset.8.Single drug glucocorticoid,glucocorticoid plus immunoglobulin,single drug TPO,TPO combined with other medication are all effective for ITP.9.Because of the limited number of cases,the above conclusions need to be confirmed by increase the sample size studies.