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目的分析儿童急性特发性血小板减少性紫癜(ITP)不同治疗方案的疗效,并探讨影响其远期预后的主要因素。方法分析2006年1月至2008年12月就诊于我院的72例儿童急性ITP患儿的不同治疗方案的近期疗效,并分析相关因素与患儿远期预后的关系。结果①泼尼松组显效率66.6%,有效率78.6%;无效9例(21.4%);而丙种球蛋白组(丙球组)显效率90.0%,有效率96.7%,无效1例(3.3%);丙球组的近期疗效明显优于丙球组(P<0.05);②丙球组的血小板开始上升时间、达峰值时间和恢复正常时间明显短于泼尼松组,而治疗第7天的血小板值则明显高于泼尼松组,显示丙球在早期提高血小板值方面的优势;③全组患儿中位随访56(12～70)个月,共有60例患儿治愈,12例患儿转为慢性ITP,不同治疗方式的预后转归无明显差异(P>0.05);④Logistic回归分析显示:患儿起病至开始治疗的时间、治疗后血小板开始上升的时间和血小板恢复正常的时间是影响预后的相关因素。结论对于儿童急性ITP患者应该早发现、早诊断、早治疗,特别是早期应用丙种球蛋白,可明显促进血小板的早期恢复,减少转为慢性ITP的可能性,应该作为一线治疗药物。
Objective To analyze the curative effect of different treatment regimens of acute idiopathic thrombocytopenic purpura (ITP) in children and to explore the main factors affecting its long-term prognosis. Methods The clinical efficacy of different treatment regimens in 72 children with acute ITP treated in our hospital from January 2006 to December 2008 was analyzed. The relationship between the factors and the long-term prognosis of children was analyzed. Results ① In the prednisone group, the effective rate was 66.6%, the effective rate was 78.6%; the ineffective in 9 cases (21.4%); the effective rate was 90.0% in the immunoglobulin group ). The short-term curative effect of C group was obviously better than that of C group (P <0.05). ② The mean time to platelet rise, peak time and recovery time of C group was shorter than that of prednisone group Of the platelet values were significantly higher than the prednisone group, showing the advantages of early treatment of ciliary ball value in the early; (c) The median follow-up of 56 (12 to 70) months, a total of 60 patients were cured, 12 cases (P> 0.05) .④Logistic regression analysis showed that the time from the onset of treatment to the start of treatment, the time when the platelet began to rise after treatment and the platelet recovery were normal Time is a relevant factor affecting the prognosis. Conclusion Early detection, early diagnosis and early treatment of acute ITP in children should be promoted. Early application of gamma globulin may promote platelet early recovery and reduce the possibility of converting to chronic ITP. It should be used as first-line treatment.