Influencing Factors In The Chronicity Of Immune Thrombocytopenia In Children

Purpose Immune thrombocytopenia(ITP)in children is the most common hemorrhagic disease of immune-mediated children,which can occur at all ages.Most children with ITP have an acute onset.Although most of them have a good prognosis,20%-40%of children will develop chronic ITP(chronic immune thrombocytopenia,c ITP).This study focuses on exploring the related influencing factors in the chronicity of childhood immune thrombocytopenia,and to provide basis for judging the prognosis and treatment of ITP in children.Methods The clinical data(including gender,age,predisposing factors,PLT,ALC,antinuclear antibodies,Megakaryocyte count),Treatment at diagnosis and treatment response(time for platelet recovery to≥100×10~9/L after initial treatment)of children with ITP admitted to The Second Affiliated Hospital of Anhui Medical University in the past 5 years were retrospectively analyzed and followed up for more than 1 year.According to the inclusion criteria,the eligible cases(328 cases in total)were selected and collected through medical record system retrieval,outpatient clinic and telephone follow-up.Independent influencing factors affecting the prognosis of children with ITP are obtained through single-factor and multi-factor logistic analysis,evaluating their predictive value for the prognosis of ITP in children.Results1.The preoperative basic information of the patient:Among 328 children with ITP,185 were males(56.4%)and 143 were females(43.6%).The male-to-female ratio was1.29:1.00,and the median age was 2.2 years(1month-13.5years old);the newly diagnosed ITP was 208 Patients(n ITP,64%),54 cases of persistent ITP(p ITP,16%),66 cases of chronic ITP(c ITP,20%),and the remission rate within one year was79.9%.2.The results of univariate analysis showed that:age,pre-morbidity history of infection and vaccination,antinuclear antibodies,initial absolute lymphocyte count(ALC),and treatment options is related to the prognosis of the children(P<0.05).Gender,PLT,megakaryocyte number and Thromocytogenic megakaryocyte were not related to the prognosis(P>0.05).Multivariate analysis showed the history of infection and vaccination before onset,initial treatment options,and initial ALC at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP(P<0.05).3.According to the initial diagnosis treatment plan,the cases of children with ITP were divided into:glucocorticoid treatment group(single-drug group),glucocorticoid combined with immunoglobulin treatment group(double-drug group).The treatment response of the two groups of different treatment programs was different,and the time of platelet recovery to 100×10~9/L in the double-drug group ITP was shorter(P<0.001).The incidence of c ITP in the single-drug group was 32.1%,while the other was 17.4%,the difference was statistically significant(P<0.05).4.There was a statistically significant difference in the mean values of ALC among the three groups of ITP children with different prognostic types(P<0.001),and the c ITP group was lower.According to the different reference values of lymphocytes in children of different ages,the ages were stratified(≤6 years old and>6 years old).Among different age strata,the mean values of newly diagnosed lymphocyte counts of children with ITP in different prognosis groups were still statistically different(P<0.05).5.The receivers operating characteristic(ROC)was drawn with the development of chronic disease(course>12 months)as state variable and ALC or ALC combined with preceding infection or vaccination history as test variable.The results show that when the absolute value of lymphocytes is 3.80×10~9/L,the area under the curve is the largest(0.787),the sensitivity is 80.6%,and the specificity is 65.53%(P<0.001).the combined results show that the maximum area under the curve is 0.859,the sensitivity is 77.61%,and the specificity is 78.41%.Conclusion The initial treatment plan combined with IVIG can reduce the occurrence of chronicity in children with ITP,and its efficacy is better than of the single corticosteroids group alone(the platelet recovery time is shorter);history of preceding infection or vaccination,initial ALC at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP,and the combination of the two has a better predictive value for the prognosis.