| Objective Primary immune thrombocytopenia (ITP) is the most common pediatric bleeding disorders. In recent, an international working group reached a consensus on the Standardization of ITP, in which the panel recommended the phases of ITP to be newly diagnosed ITP, persistent ITP and chronic ITP. Different from that the most newly diagnosed ITP patients will response to the regular treatment well, the patients with persistent and chronic ITP showed poor response to the first line treatment. So that this study is aimed to analysis the clinical features and therapeutic effect of the patients with persistent and chronic ITP using the new concept by definitions and terminology in ITP, and to provide more data for the evidence based clinical practice.Methods 103 patients with persistent and chronic ITP were recruited in this study. The gender, age, inducement, virus infection, bleedings, platelet count at checking in, the methods of treatment, and the therapeutic effect were analyzed and evaluated. The statistics of the data analysis was performed by SPSS 13.0. Results(1)The median age of patients with persistent and chronic ITP was 94 months. The percentage of the patients with persistent and chronic ITP aged over 3-year-old was 96.1%(n=99), patients aged 3~7-year-old was 37.9%(n=39),and patients aged 7~13-year-old was 50.4%(n=52).The ratio of male(55.3%) to female(44.7%) patients with persistent and chronic ITP was 1.24:1.(2)The incidence of inducement in patients with persistent and chronic ITP was 73.8%(n=76). The most important inducement was upper respiratory infection(89.5%,n=68), and the incidence of vaccine inoculation as inducement in persistent and chronic ITP was quite low(n=0). The incidence of viral serum antigen-positive in persistent and chronic ITP was 45.0%(n=36), and the incidence of mixed infection was 36.1%(n=13). The percentage of Coxsackie virus-positive was 27.5%, and Epstein-Barr virus and Human Parvovirus B19 were both 16.25%.The median age of children with CBV,EBV or HPVB19 infection was more than 3 years old. The ratio of Cytomegalovirus in persistent and chronic ITP was low, with median age 20 months.(3)The incidence of epistaxis in patients with persistent and chronic ITP was 44.7%(n=46), the incidence of oral mucosal bleeding was 16.5%(n=17), and the incidence of other bleedings was 38.8%(n=40). There were 26 patients with hemorrhagic anemia in persistent and chronic ITP, and the percentage of mild anemia was 80.7%. The percentage of patients with platelet counts at checking in less than 25×10~9/L in persistent and chronic ITP was 70.9%(n=73). About 1/4 patients whose platelet counts less than 25×10~9/L had hemorrhagic anemia with median hemoglobin 103g/L. There were no relevance between bleedings and thrombocytopenia, and no statistically significant between anemia degree and thrombocytopenia.(4) The percentage of patients with insisted treatment in persistent and chronic ITP was 59.2%(n=61), and the rest patients was treated without insisted treatment. The incidence of mucosal bleedings in patients with insisted treatment(55.7%,n=34) was lower than that in patients without insisted treatment(69.0%,n=29), but there were no statistically significan between the two groups. The incidence of hemorrhagic anemia in patients with insisted treatment(8.2%,n=5) was statistically lower than that (50.0%,n=21) in patients without insisted treatment(χ~2=23.034,P<0.001).(5)The ratio of megakrocytes increased in patients with persistent and chronic ITP was 88.3%(n=83) with a median megakrocytes 211. The therapeutic efficacy of children with increasing megakrocytes increased was lower than that of chidren with normal megakrocytes, but there were no statistically significant between increasing megakrocytes group and normal megakrocytes group(χ~2=0.354,P=0.552). Sixty-nine patiens were treated with corticosteroids only, 36 achieved complete response, 19 had response, and 14 failed to response, the therapeutic efficacy(CR and R) was 79.7%. Fourteen patiens were treated with combination of corticosteroids plus IVIG, 9 achieved complete response, 2 had response, and 3 failed to response; the therapeutic efficacy was 78.6%. Fifteen patiens were treated with combination of of corticosteroids plus VCR, 3 achieved complete response, 3 had response, and 9 failed to response; the therapeutic efficacy was 40.0%. The therapeutic efficacy of corticosteroids group(79.7%,n=55) was higher than that of corticosteroids plus IVIG group(78.6%,n=11), but there were no statistically significant between the two groups(χ~2=0.052,P=0.82). The therapeutic efficacy of corticosteroids plus IVIG group(78.6%,n=11) was statistically higher than that(40.0%,n=6) of corticosteroids plus VCR group(χ~2=4.441,P=0.035). The therapeutic efficacy of corticosteroids group(79.7%,n=55) was statistically higher than that(40.0%,n=6) of corticosteroids plus VCR group(χ~2=9.772,P=0.002).Conclusions(1)The patients with persistent and chronic ITP were mostly preschool and school age children, when patients with newly diagnosed ITP were infants and toddlers.The majority of patients with persistent and chronic ITP were male, but the gender was not a risk factor for persistent and chronic ITP.(2)The very important inducement for children with persistent and chronic ITP was upper respiratory infection. Virus infection may play a very important role in the ocurrence or recurrence of ITP. The incidence of pathogen mixed infection in persistent and chronic ITP group was high, and the incidence of CMV-IgM-positive was low.(3)The bleedings of patients with persistent and chronic ITP were various, in which mucosal bleeding was the main bleeding manifestation, and the bleeding degree was mild. The degree of thrombocytopenia in persistent and chronic ITP was severe. The thrombocytopenia had no relevance to bleedings and to anemia degree. So the disease severity was judged by the clinically relevant bleedings.(4)The insisted treatment with corticosteroid at a low dose can effectively mitigate bleedings and reduce the incidence of hemorrhagic anemia in persistent and chronic ITP.(5)The therapeutic efficacy of patiens with increasing megakrocytes was low than that of patients with normal megakrocytes. The therapeutic effect of corticosteroids and corticosteroids plus IVIG were statistically higher than that of corticosteroids plus VCR.
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