Clinical Analysis Of Patients With Antinuclear Antibody Positive Immune Thrombocytopenia

Purpose:Observe the clinical characteristics of patients with anti-nuclear antibody positive and negative immune thrombocytopenia and the difference in response to different treatment chooses to provide a proposal for the choice of treatment for patients.Patients and Methods:We selected 87 ITP patients who were hospitalized in XX Hospital from October 2006 to July 2019.All patients were in line with the diagnostic criteria of the 2016 version of the Chinese ITP Guidelines and have been tested for ANA,and the ANA-positive ITP patients did not conform the diagnostic criteria for connective tissue disease and undifferentiated connective tissue disease after consultation with the Department of Rheumatology and Immunology.Patients who have been followed up for more than 1 month.We excluded the patients whose diagnosis were unclear,who were secondary ITP,who were suffered connective tissue disease or undifferentiated connective tissue disease,and had infectious disease,did not test ANA,or did not use standardized treatment,or follow-up time is less than 1month.We divided them into two groups of the ANA-positive group and the ANA-negative group according to the ANA test results.Then comparing their basic conditions,laboratory test results,and therapeutic response.The basic conditions include age,gender,medical history,bleeding scores,and clinical stage.The test results include the differences in the patient’s platelet count,bone marrow megakaryocyte count,plate-producing megakaryocyte count,immunoglobulin and complement levels before treatment.When comparing the efficacy of ANA-positive group and ANA-negative group,patients were divided into two groups according to the different treatment regimens used.The first-line drug group was treated with high-dose dexamethasone or gamma globulin for intravenous injection or HD-DXM combined with IVIg treatment;rh TPO group was treated with recombinant human thrombopoietin.The number of patients using cyclosporine A combined with prednisone,or Danazol combined with PDN was relatively small,and no efficacy analysis was performed.Count the changes in PLT counts before and after treatment in the ANA-positive group and ANA-negative group,and analyze the patient’s complete response,response,overall response,and no response and recurrence.Finally,analyzing the relevant influencing factors of the patients with OR and NR.Results:1.There were 109 patients be selected before enrollment,22 patients did not conform the selection criteria.The details were as follows: 7 patients did not test ANA,1 patient had rheumatoid arthritis and Sjogren’s syndrome,and 14 patients did not use first-line and second-line ITP drugs to.In the end,87 patients were in line with the inclusion criteria.2.There were 22 patients in the ANA-positive group and65 patients in the ANA-negative group.There are no statistically difference of the gender,age,medical history,bleeding score and clinical stage between ANA-positive ITP patients and ANA-negative ITP patients.3.There are no significantly differences in the level of PLT counts,immunoglobulin levels,complement C4,bone marrow megakaryocytes,and plate-producing megakaryocytes before treatment between ANA-positive patients and ANA-negative patients(P>0.05).However,the level of complement C3 in ANA-positive patients was lower than ANA-negative patients,of the ANA-positive patients were(0.88±0.27)g/L,and the ANA-negative patients were(1.14±0.29)g/L,P=0.001.4.Patients who were used first-line drugs,there was no significantly difference in the level of PLT counts on the 3rd,7th,14 th,and 28 th days,and the CR or OR rates on the 14 th and 28 th days after treatment between the ANA-positive and ANA-negative patient groups(P>0.05).5.When patients were treated with rh TPO,there was no significantly difference in the level of PLT counts on the 3rd,7th,14 th,and 28 th day,and the CR or OR rates on the 14 th and 28 th days after treatment between the ANA-positive and ANA-negative patient groups(P>0.05).6.There are no significantly difference in the short-term recurrence rate between the ANA positive patients and the ANA negative patients(P>0.05).7.The treatment plan is an effect factor(P=0.045).Regression analysis illustrated that there was no statistical difference between OR and NR patients of their age,gender,bleeding score,medical history time,PLT counts before treatment,ANA,and immunoglobulin level(P>0.05).Conclusion:1.The level of complement C3 is lower in the ANA-positive patients than ANA-negative patients.2.There are no significantly difference between ANA-positive and ANA-negative ITP patients about the age,gender,medical history,clinical stage,bleeding score,immunoglobulin,complement C4,the number of bone marrow megakaryocyte,and plate-producing megakaryocyte number.3.There is no significantly difference in the short-term efficacy of using first-line drugs or rh TPO to treat between ANA-positive and ANA-negative patients.4.ANA is not a factor influencing the efficacy of OR and NR patients.