Effect Of Different First-line Treatment On Children's Immune Thrombocytopenia Course

ObjectiveIn this study,we followed up by telephone or clinical data to understand the proportion of patients with newly diagnosed ITP who were converted to chronic ITP after three different treatment regimens of immunoglobulin,glucocorticoid and immunoglobulin combined with glucocorticoids to provide a reference for the choice of clinician treatment.MethodsThe medical records were retrieved with the patients diagnosed with immune thrombocytopenia admitted to the Department of Pediatrics,First Affiliated Hospital of Zhengzhou University from June 01,2015 to February 01,2018.The unified ITP clinical data survey registration was prepared,including the gender,age,course of disease,bleeding,peripheral blood Ig complement levels,peripheral blood lymphocyte subset and treatment plan.According to the age of onset and treatment plan,the qualitative data were analyzed by chi-square test.The test standard was?=0.05,P<0.05.The difference was statistically significant.The statistical software used SPSS21.0.Results1.There were 606 children with ITP in this study,including 357 males,accounting for 58.75%,and 249 females,accounting for 41.25%.The male to female ratio was 1.43:1.2.There were 418 patients in the>1month to?3 years old group,including258 males and 160 females;125 patients in the>3 years to?6 years old group,including 64 males and 61 females;63 patients in the>6 years to?9 years old group,including 35 males and 28 females.3.Among the 606 ITP patients,82 patients were chronic ITP patients,accounting for 13.53%.Among the chronic patients,43 were males and 39 were females.There were 314 males and 210 females in non-chronic patients.There was no significant difference in gender ratio between chronic and non-chronic groups.4.In this study,332 patients underwent platelet antibody test,including 256positive cases and 76 negative cases.There was no significant difference among different age groups.Also,there was no significant difference in the positive rate of platelet antibodies between chronic and non-chronic groups.5.In this study,82 patients were chronic,accounting for 13.53%,20 of them were in normal platelet count within 1-2 years in the disease,accounting for 24.39%.So far,the overall recovery rate of 606 patients with ITP was 89.60%.6.In the>1month to?3 years old group in this study,there was a statistically significant difference between the different treatments groups(P<0.05).In the pairwise comparison,the difference between IVIG and GC group was statistically significant(P<0.0167).The difference between the IVIG group and the combination group was statistically significant(P<0.0167).The difference between the GC group and the combination group was not statistically significant(P>0.0167).7.In the>3 years to?6 years old group in this study,there was a statistically significant difference between the different treatments groups(?~2=12.948,P<0.05).In the pairwise comparison,the difference between IVIG and GC group was statistically significant(?~2=9.859,P<0.0167).The difference between the IVIG group and the combination group was statistically significant(?~2=9.847,P<0.0167).The difference between the GC group and the combination group was not statistically significant(?~2=0.614,P>0.0167).8.In the>6 years to?9 years old group in this study,There was no significant difference in the comparison between different treatments(P>0.05).9.In this study,there were significant differences in different ages treated with IVIG(P<0.05).In the pairwise comparison,the difference between the>1month to?3 years old group and the>3 years to?6 years old group was not statistically significant(P>0.0167).The difference between the>1month to?3 years old group and the>6 years to?9 years old group was statistically significant(P<0.0167).The difference between the>3 years to?6 years old group and the>6years to?9 years old group was statistically significant(P>0.0167).10.In this study,there were no significant differences in different ages treated with GC(P>0.05).11.In this study,there were significant differences in different ages treated with IVIG combined with GC groups(?~2=15.933,P<0.05).In the pairwise comparison,the difference between the>1 month to?3 years old group and the>3 years to?6 years old group was statistically significant(?~2=9.150,P<0.0167).The difference between the>1 month to?3 years old group and the>6 years to?9 years old group was statistically significant(?~2=12.404,P<0.0167).The difference between the>3 years to?6 years old group and the>6 years to?9years old group was not statistically significant(?~2=0.565,P>0.0167).Conclusion1.For children>1 month to?6 years old,the the use of immunoglobulin therapy in the newly diagnoed ITP is less likely to be chronic than the use of GC or combination therapy.The treatment with IVIG is a protective factor in the prognosis of ITP.2.For children>1 month to?3 years old,both the immunoglobulin and the combination therapy are the protective factor in the newly diagnosed ITP than in the elderly group,but immunoglobulin therapy is better.