Correlation Between Clinical Data And Classification And Influencing Factors Of Curative Effect In 242 Childhood ITP

Objective:Immune thrombocytopenia(ITP)is the most common hemorrhagic disease in children.The purpose of this study is to retrospectively analyze the clinical data of childhood ITP,to initially understand its clinical characteristics,and to explore the correlation between peripheral blood routine related parameters and ITP severity classification;at the same time,to analyze the factors affecting treatment outcome.Methods:Retrospectively included 242 children under 14 years of age with ITP who were admitted to the Pediatrics of the Affiliated Hospital of North Sichuan Medical College from December 2013 to August 2019.We analyze the general information such as age,gender,treatment,infection,bleeding site and bleeding manifestation,as well as peripheral blood routines at admission,3 days after admission,and at discharge;all variables are tested for normality using the Kolmogorov-Smimov method.Continuous variables are expressed as average ± SD(X±s)or median,P25 and P75,categorical variables are expressed in frequency;the chi-square test is used for categorical variables,and the curative effect of different ages stage is compared using chi-square segmentation;children in normal control group and ITP group are tested by independent sample T test or Mann-Whitney U test according to the data normality.Receiver operating characteristic curve is used to analyze relevant parameters for predicting the severity of childhood ITP.According to normality,using paired sample T test or Wilcoxon test to compare with blood routine parameters of the same patient before and after admission;Univariate ordered logistic regression analysis is used to find the factors that affect curative effect.Results:(1)The average age of 242 children with ITP at admission is 42.99±41.47 months,and the average length of hospital stay is 6.160±2.869 days.The highest constituent ratio is infants and young children,with a total of 129 cases(53.3%);there are 141 males and 101 females,the male-to-female ratio is 1.4:1.There is no significant statistical difference in the incidence of sex between all ages(?2=2.998,P=0.223).According to different bleeding manifestations,54 children with severe ITP and 188 children with mild ITP are admitted at the time of admission.The median of platelet is 11.00(4.00-24.00)× 109/L when the patients are admitted to hospital.68.6%of the patients with PLT less than 20×109/L at admission.The bleeding manifestations is mainly mild bleeding,including 222 cases of skin bleeding,69 cases of mucosal bleeding,and 48 cases of organ bleeding.No intracranial hemorrhage occurred in all children.Of all children,A total of 233 patients are treated with methylprednisolone and 156 patients are treated with IVIG,of which 82 patients are treated with methylprednisolone alone and 5 patients are treated with IVIG alone,and a total of 151 children are treated with both.(2)The areas under the ROC curve of PLT,GR,PCT,NLR are 0.660(95%CI 0.587?0.748,P=0.000),0.378(95%CI 0.287?0.469,P=0.008),0.811(95%CI 0.695?0.926,P=0.000),0.359(95%CI 0.271?0.448,P=0.002),among them,the sensitivity and specificity of PCT prediction of mild and severe typing are the highest(78.2%and 84.2%),the best cutoff value is 0.021.With PCT less than 0.021,the child is more likely to have severe ITP.(3)There is no statistically significant difference between gender,infection,and curative effect(?2=0.786,0.024,P=0.675,0.988);There are statistically significant differences between age stage and curative effect(?2=13.020,P=0.011).Further univariate ordered logistic regression analysis showed that age stage and the dose of glucocorticoid are independent influencing factors for ITP curative effect.The probability that the curative effect in infants and preschool years is at least one grade better than that in school age is 2.604 and 3.504 times.The younger the child,the higher the probability of achieving response or complete response.Ultimately,the impact dose of glucocorticoid is 0.276 times more likely to be at least one grade higher than the general dose of glucocorticoid,the probability of curative effect of impact dose glucocorticoid combined with IVIG is 0.414 times higher than that of general dose glucocorticoid combined with IVIG.Compared with the general dose of glucocorticoids,the therapeutic advantage of impact dose glucocorticoids or impact dose glucocorticoids combined with IVIG is not obvious.There is no statistically significant difference in the curative effect between the general dose of glucocorticoid and the general dose of glucocorticoid combined with IVIG(P=0.515).Conclusion:(1)ITP occurs in children at all ages.The younger the age,the higher the incidence;gender has nothing to do with the incidence of ITP children;PLT decreases significantly when admitted to hospital,but the bleeding is mainly mild Skin bleeding is the main form of bleeding;(2)PCT has the highest sensitivity and specificity in predicting the severity of ITP in children.PCT is better than PLT<10×109/L proposed by some domestic scholars as the classification index.It can be used as one of the classification indicators.The best cutoff value is 0.021.With PCT less than 0.021,the child is more likely to have severe ITP;(3)Age and dose of glucocorticoid therapy are independent influencing factors for the efficacy of the children.Younger age at the onset is one of the factors for faster recovery.There is no definite correlation between the short-term effect of general dose glucocorticoid combined with IVIG and that of general dose glucocorticoid alone.When the children's bleeding symptoms are not serious or the family members refuse to use IVIG,glucocorticoid therapy can be chosen only.Compared with the general dose of glucocorticoids,the therapeutic advantage of impact dose glucocorticoids is not obvious,and only the general dose of glucocorticoids can be selected when the children do not have life-threatening bleeding symptoms.