Clinical Characteristics And Efficacy Analysis Of Primary Immune Thrombocytopenia In Children

BackgroundPrimary immune thrombocytopenia (ITP) also known as idiopathic thrombocytopenic purpura (ITP), is traditionally divided into acute and chronic forms based on the duration of thrombocytopenia. Acute ITP is lasting for less than6months, and chronic ITP is persisting for more than6months. But there is still20%-30%of children duration of6-12months can be spontaneous remission. For chronic ITP’s boundary has controversial in abroad,2007International Working Group reached a new consensus on ITP’s diagnosis, classification and treatment standards.In May2013,China has also reintroduced a new treatment recommendations for children,and the typing of new treatment recommendations are agreed with the International:newly diagnosed ITP, persistent ITP and chronic ITP. But according to the latest treatment recommendations, not yet a large number of studies about ITP children’ clinical characteristics and efficacy has been reported in China.ObjectiveThe purpose of this study was according to the latest treatment recommendations to analyze the clinical characteristics of all types of ITP,relative factors which may affect ITP’s efficacy, and investigate the efficacy of different treatment.MethodsWe retrospectively analyzed of360ITP children of clinical data and follow-up by phone or outpatient at The First Affiliated Hospital of Xinxiang Medical University Hospitalization, from January1,2008to December30,2013. Statistical clinical and laboratory characteristics of all types.Treatment divided into single hormone, hormone combined with low doses of globulin and hormone combined with high-dose of globulin three methods. Statistical analyses were performed using SPSS version16.0.Results1. A total of360ITP children were included in our study, Newly diagnosed ITP, persistent ITP, chronic ITP accounted for60.8%,26.9%,12.3%.The male to female ratio was1.7:1,there were not significant differences in the gender distribution of all groups (P>0.05). Infants was more common to see of all typs,the proportion of all typs respectively was67.6%、45.4%、18.2%,there were significant differences in the age distribution of all groups (P<0.05). The incidence of all types mainly in the spring and summer, but after x2test, there were not significant differences in the season distribution of all groups (P>0.05).2.The proportion of incentives in all types was64.5%/53.6%/34.1%, and there was no significant defferences in chronic ITP (P<0.05); Mean history of all types were (11.49±7.50) days,(41.55±10.55) days,(402.83±28.26) days, the history of chronic ITP was longer than the other two types (P<0.05).3. This group62.8%hadn’t existed bleeding or only with mild bleeding,27.2%with moderate bleeding and10.0%with severe bleeding (0.5%with Intracranial hemorrhage), no or mild bleeding more common to see of all types. No or mild bleeding of all types accounted for64.8%,61.9%,54.5%,there were significant differences in the degree of bleeding distribution of all types (P<0.05). Mean platelet count of all types when they first saw a doctor was (11.75±5.86)×109/L、(18.02±2.43)×109/L、(19.27±4.32)×109/L,there were not significant differences of all types (P>0.05). All degrees of bleeding of diagnosed mean platelet levels were (16.68±5.59) X109/L、(15.49±6.19)×109/L、(12.38±8.14)×109/L、there were not significant differences of all types (P>0.05). Bone marrow cytology, megakaryocytes of all types were (190.60±110.20)、(217.12±121.30)、(270.50±140.25). Among these3types,Chronic ITP have more higher megakaryocytes(P<0.05). Giant plates of all types were (2.53±3.69)、 (2.80±4.14)、(2.5±4.99), there were not significant differences of all types (P>0.05).4. A total of360ITP children part etiology test positive; majority no abnormalities of Serum immunoglobulin and complement, Minority platelet-associated antibodies (PAIg) positive; T lymphocyte subsets, CD3+, CD4+, CD4+/CD8+decrease with different drgrees,and CD8+increased.5.Efficacy of three treatments were73.6%、77.6%、86.4%, hormone combined with high-dose gamma globulin treatment group had higher efficacy than others(P<0.05). Efficacy of all types respectively were82.6%.76.3%.65.9%.Efficacy of Chronic ITP were lower than other types (P<0.05).6. Age, megakaryocytes, bone marrow megakaryocytes, platelets in fist diagnosed may be an independent predictive factor of affecting the efficacy.Conclusions1. The main onset age of newly diagnosed and persistent ITP was infancy,and usually had incentives;With age increasing,the incidence of chronic ITP was growing, and have a long history.2. No or mild bleeding were common to see of all types,severe bleeding in ITP patients was rare, but severe bleeding in chronic ITP had a obvious. All types of ITP children who had higher level of megakaryocytes were more common to see, and especially in chronic ITP.3. There was higher efficacy of dexamethasone combined with high-dose gamma globulin;Efficacy relevant with age, bone marrow megakaryocytes, platelets in fist diagnosed.