| Primary immune thrombocytopenia(ITP)is the most common hemorrhagic disorder in childhood,The main characteristics are skin and mucosa spontaneous hemorrhage,thrombocytopenia,prolonged bleeding time and bone marrow megakaryocyte maturation disorder.the onset typically occurrs a few days or weeks after viral infection or vaccination.ITP in childhood shows a benign clinical course,and most patients spontaneously resolve or recover from thrombocytopenia in response to corticosteroids or intravenous immunoglobulins.A small number of them may develop chronic or refractory ITP,which makes a tremendous difference in the quality of life.By evaluating the related factors about prognosis of ITP,clinicians can develop a better understanding of the possible clinical courses of individual patients,which helps to relieve their anxiety,lower the negative effects on daily life and guide treatment as well.Here we discussed the possible relevant prognostic factors about ITP in children by statistic analysis.Objective: 1.Summarize the clinical features of ITP patients hospitalized in Shanghai Children,s Hospital during January 2010 to August 2015.2.To analyze relevant factors associated with the prognosis.3.To optimize the treatment plan by analyzing treatments being used in our department,compared with researches at home and abroad.Methods: A total of 448 patients diagnosed as Primary immune thrombocytopenia between January 2010 and August 2015 in Shanghai Children,hospital were retrospectively analysed.The clinical characteristics,treatment protocols were recorded.Statistical analyses were performed using the commercial SPSS 21 packet program.Results: 1.A total of 448 children were included in this study.The median follow-up period was 32 months(range,12–80 months).Among the 448 cases,321 were diagnosed as newly diagnosed ITP,The final diagnosis of 57(12.7%)and 70 patients(15.6%)was persistent and chronic ITP,respectively.Effective group 399 patients,non-responders 49 patients,ratio was 89.1%,10.9%respectively.The male-to-female ratio was1.6:1,The male/female ratio with Effective group and non-responders was not statistically significant.The median age at diagnosis was 18 months(ranged from 10 days to 14years).The median age at diagnosis was 1.5 years(range,10 days to 14years);17 patients(26.6%)with age of <1 year,9 patients(14.1%)with age of 10 days to 1 year,31 patients(38.9%)with age of 1 year to10 years and 12patients(5.1%)with age of ?10 years.age distribution between Effective group and non-responders was not statistically significant.2.Among the 448 patients,Thirty-nine patients(52.5%)were reported to have antecedent infection,and 9 patients(19.7%)received vaccinations <14 days before diagnosis of thrombocytopenia.Twenty-one patients(27.8%)had neither recent vaccination nor clinical evidence of recent infection.3.Bleeding degree evaluation was carried out in 431 patients,Bleeding symptoms proved predominantly mild(80%),with moderate bleeding symptoms present in the minority of patients(19.5%).However,two patients(0.5%)in the study developed serious bleeding.treatment effects between the two groups makes no differences.4.Mean platelet counts were 15.39×109/L,21.12×109 /L in effective group and nonresponders respectively,differences between the two groups were significant.Mean time before onset was seven days and 34 days respectively,nonresponders was longer than effective group,differences between the two groups were significant.the mean time that platelet started to raise was 1.28 days and 1.69 days,differences between the two groups were significant.MPV,WBC and ALC between the two groups makes no difference.5.404(90.2%)patients ultimately received treatment for thrombocytopenia,54(12%)of the patients received steroids,18(4%)of them received Iv Ig,332(74.2%)received steroids and Iv Ig,44(9.8%)of the children didn,t receive any treatments.differences between the two groups were not significant.6.Lymphocyte subsets,Immune globulin ratio between the two groups were not statistically different.7.The peak platelet was the independent predictive factor that influerces efficacy.Conclusions: 1.The age distribution of two groups centralized from 1 to 10 years,most of the patients were reported to have antecedent infection or vaccination before the onset of thrombocytopenia.2.Bleeding symptoms proved predominantly mild,The incidence of severe bleeding such as intracranical hemorrhage was rare.3.Therapeutic regimen had no obvious effect on treatment efficacy,the peak platelet count was the independent predictive factor that influerced efficacy. |
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