| Background: Idiopathic thrombocytopenic purpura(ITP),also known as idiopathic thrombocytopenic purpura or immune thrombocytopenic purpura,is a kind of immune-mediated thrombocytopenia syndrome which is characterized by varying degrees of bleeding.The patients with mild condition can be asymptomatic,while severe cases may suffer fatal bleeding.Currently,the first-line treatment for ITP is drug treatment.Splenectomy,which is mainly used in the ITP patients with ineffective drug treatment,is the second-line treatment for ITP.The effective rate of splenectomy is about 70%-90%[1].It seems that some patients are still ineffective after cutting the spleen,and even with a risk of surgical complication,such as septic shock,DIC,respiratory distress syndrome,and dangerous infection[2].Therefore,knowing preoperative risk for splenectomy will reduce unnecessary surgery.Objective: to review the prognostic factors of ITP effect in the treatment of splenectomy,which makes a meta-analysis to confirm the effective factors of splenectomy for ITP.Methods: we performed a systematic search of pubmed,embase,cochrane library,CNKI,VIP and WANFANF database to identified all eligible literature about ITP spleen resection(including dissertation)from time of building a library to March 2018.We performed this metaanalysis by using Reveman5.3 software.The fixed effect model or random effect model was applied according to the size of the heterogeneity.The counting data used odds ratio(OR)and 95% confidence interval(CI)and measurement data used weighted mean difference(WMD)and 95% confidence interval(CI).Results: We searched a total of 25 studies,among which 9 studies in Chinese and 16 studies in English.The study included a total of 1782 patients including 1372 valid patients,and 410 invalid patients.Statistical analysis results which showed the data of valid and invalid groups in patients with ITP treated with splenectomy were: 1.Counting data: a.male gender,OR= 0.84,95% CI [0.65,1.09],p= 0.19.b.hormone treatment dependent,OR=2.58,95% CI [1.57,4.22],p=0.0002.c.platelet antibody positive,OR= 1.28,95%CI [0.39,4.23],p= 0.68.d.responsive Immunoglobulin therapy,OR= 2.15,95%CI [1.32,3.49],p= 0.002.e.accessary spleen,OR=1.15,95%CI [0.61,2.16],p=0.68.2.Measurement data: a.age,WMD=-11.2,95%CI [-18.04,-5.01],p= 0.0005.b.preoperative duration of illness WMD=-0.56,95%CI [-9.81,8.69],p=0.91.c.Preoperative platelet count.WMD= 16.81,95%CI [6.95,26.68],p=0.0008.d.Postoperative platelet peak,WMD=215.22,95%CI [167.45,263.00],p<0.00001.e.spleen weight,WMD=12.49,95%CI [-4.68,29.67],p=0.15.f.Number of bone marrow megakaryocytes,WMD=21.68,95%CI[-8.67,52.03].Conclusions: This meta-analysis shows that there was no difference in gender,platelet antibody,accessory spleen,preoperative diabetes duration,spleen weight,and number of bone marrow megakaryocyte between effective and ineffective.They cannot influence result of splenectomy for the treatment of ITP.But age,hormone therapy,immunoglobulin therapy,preoperative platelet count and postoperative platelet peak were different between two groups,which could influence the effect of splenectomy for ITP. |
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