Analysis Of Risk Factors For Chronic Immune Thrombocytopenia In Children

objectiveThrough the retrospective analysis of the data of initial hospitalization,follow-up and follow-up of children with immune thrombocytopenia(ITP),to understand the risk factors of children's ITP chronic,and to accumulate clinical experience,so as to achieve early diagnosis and timely intervention of children's chronic ITP.methodsFrom January 1,2016 to December 31,2018,we selected ITP children(excluding readmission children and newborns)who were hospitalized in Jiangxi Children's Hospital,and analyzed the initial diagnosis of 525 children(428 non chronic group and 97 chronic group)who met the inclusion criteria.We collected the basic information,clinical performance,examination results,treatment plan and other data,and at the same time,we used outpatient follow-up or electricity Follow up the patient's condition,collect the platelet condition at least one year after the initial diagnosis,and analyze the risk factors of developing chronic ITP.results1.Among 525 children with ITP,322 were boys(61.3%),203 were girls(38.7%).The ratio of male to female was 1.59:1.Among the 525 children,the youngest was 1month 6 days,and the oldest was 13 years 3 months.The chronicity rate of ITP was18.5%,in which the chronicity rate of male children was 16.80%,and that of female children was 21.2%.There was no significant difference between sex and ITP chronicity(?~2=1.609,P>0.05).Among the children with chronic ITP,preschool children accounted for the highest proportion(34.8%),followed by school-age children(33.9%),infant children accounted for the lowest proportion(4.2%),and the difference between age and ITP was statistically significant(?~2=58.929,P<0.05).2.The slowness rate of children with type A blood was the lowest(15.70%),and that of children with type B blood was the highest(21.50%).There was no significant difference between the slowness rate of blood group and ITP(?~2=1.923,P>0.05).3.The incidence rate of ITP was the highest in summer(25.2%),followed by autumn(21.3%),and the lowest in spring(12.5%).There was a significant difference between the incidence season and ITP(?~2=8.298,P<0.05).4.The chronic rate of children with acute onset was 14.2%,and that of children with chronic onset was 39.3%.The difference between the onset mode and ITP was statistically significant(?~2=30.791,P<0.05).But there was no significant difference between ITP and virus infection or vaccination history before initial diagnosis(?~2=2.333,P>0.05).5.There was no significant difference in the number of platelets and megakaryocytes in bone marrow and the chronicity of ITP(?~2=3.893,P>0.05;?~2=2.637,P>0.05).6.Among 525 children with ITP,most of the children in the chronic group and non chronic group had bleeding manifestations,of which skin and mucous membrane hemorrhage was the main one.There was no significant difference between the severity of bleeding and the chronicity of ITP(?~2=4.720,P>0.05).7.There was no significant difference between humoral immune function and ITP chronicity(?~2=0.312,P>0.05;?~2=0.241,P>0.05).8.In chronic group,hormone combined with gamma globulin and hormone therapy were the main treatment,while in non chronic group,symptomatic treatment and hormone combined with gamma globulin were the main treatment,but there was no significant difference between the treatment and ITP(?~2=6.019,P>0.05).9.The risk factors of chronic thrombocytopenia were analyzed by univariate and multivariate non conditional logistic regression analysis.Univariate analysis showed that there were statistically significant differences between the first diagnosis age,onset mode,onset season and ITP.Multivariate analysis showed that compared with infants,children in early childhood,pre-school and school-age turned into chronic ITP(chronic immune)The risk is even greater(OR=2.600;OR=5.688;OR=6.037);The risk of conversion to CITP in children with chronic onset is 2.317 times higher than that in children with acute onset(OR=2.317).Abnormal humoral immune function,severe bleeding,virus infection or vaccination history(API)are the protective factors for ITP to become chronic.conclusionsThe risk of chronic ITP in children is closely related to the age of initial diagnosis,the mode of onset,the history of virus infection or vaccination before onset,the severity of bleeding and humoral immune function.Infants can be regarded as a group with good prognosis.The age of first diagnosis is early childhood,preschool and school age,chronic onset,no history of virus infection or vaccination before onset,mild bleeding and normal humoral immune function are the risk factors for chronic ITP in children.