A Clinical Anaylsis Of Children With Acute Immune Thrombocytopenic Purpura

Objective: 1 Our purpose is to investigate the pathogenesis regularity, clinical features of children with acute immune thrombocytopenic purpura (AITP) hospitalized in HeBei Medical University 2nd Affiliated Hospital from January 2008 to December 2010. 2 Our study reviewes different treatment regimes of AITP,to seek more appropriate treatment options. 3 Learning a large number of medical articles, get the summary progress of AITP.Methods: 1 Choose patients diagnosed as AITP between January 2008 to December 2010 hospitalized in HeBei Medical University 2nd Affiliated Hospital for research objects. 2 Using retrospective analysis method was used as characteristics of clinical situation, treatment efficacy children in hospitalized. Evaluate the efficacy of ITP in children adopted standardization from the Intercontinental Childhood ITP Study Group (ICIS). 3 119 patients selected were divided into three groups. Treatment regimes for ITP: group A, intravenous methyl-prednisolone; group B, intravenous immunoglobulin ([IVIG] total 1g/kg) + methyl-prednisolone; group C, IVIG (total 2g/kg) + methyl-prednisolone. The dose of methyl-prednisone of three groups was 30 mg/kg per d for 3 days (maximal doses daily≤500mg). After the end of these treatments, prednisone shall be taken orally for maintenance treatment. Before treatment, after three days of treatment and seven days of treatment, platelet counts were observed. 4 Statistical analyses were performed by SPSS 13.0 packet program. For descriptive statistics, the median and quartile range were used for the variables without normal distribution. In each group, platelet counts before and after treatment were compared by two related sample non-parameter test (Wilcoxon inspection methods). When platelet counts among three groups were compared, it was"Rank case"firstly, then One-way ANOVA of statistical analysis was used. The non-parameter test was used to determine the curative effect of three groups. Level of significance was set asα=0.05, except that level of significance wasα=0.017, when the curative effect was compared two of three groups.Results:1 Material general features:Of 119 children, 82 (68.9%) were males and 37 (31.1%) were females. Median age of the patients was 3.25 years. The age range of children was aged 0.08 to 13.25 years. Presenting platelet count was between 0 and 20×109/L. The hospitalized date of majority is May to March (34cases), however September to November is at least (17cases). All of children had symptoms of petechiae and/or purpura,including nasal bleeding (24,17.9%), subdural hemorrhage (2,1.5%), gastrointestinal bleeding (2,1.5%), hematuria (2,1.5%). Before onset,there was 45 cases (33.6%) with upper respiratory infection symptoms, 10 patients (7.5%) with vaccinated inoculation, abdominal pain, diarrhea with 6 patients (4.5%) (Table1).2 Comparison of platelet count within each group and among three groups The median platelet counts of three groups of children registered respectively were 8×109/L, 6×109/L,5×109/L at first. Comparison among three groups, the value of P was 0.495, which cannot think statistically significant.The data of three groups was comparable.2.1 Platelet count at three days after treatment2.1.1 Within each group: The median platelet counts of three groups at 3 days were respectively 44×109/L, 162×109/L, 120×109/L. Using two related sample non-parameter test, there was statistically significant between three days after treatment and before treatment with P<0.05(Table 2).2.1.2 Among three groups:Owing to P=0.000, P<0.05, there was statistically significant difference. And it was clear that platelet counts of both group B and C were risen apparently compared with (group A) at three days. But it is no significant difference between group B and C (P>0.05) (Table 2).2.2 Platelets counts at seven days2.2.1 Within each group: The median platelet counts of three groups at 7 days respectively were 110×109/L, 258×109/L, 264×109/L. There was statistically significant between seven days after treated and untreated with P<0.05(Table 3).2.2.2 Among three groups:Owing to P<0.05, there was statist ically significant difference. According to test, it is clear that platelet counts both group B and C were risen apparently compared with group A at the time of seven days. But the difference was no statistically significant between group B and C (P=0.773, P>0.05) (Table 3).3 Curative effect3.1 At three days: The curative effects were compared, and there was statistically significant withχ2=16.570, P=0.000, P<0.05. But a statistically significant difference was not made between group B and C (Z=-0.914, P= 0.369, P>0.05) (Table4).3.2 At three seven days: Difference of curative effects was no statistically significant (χ2=20.417, P<0.05). Both group B and C were statistically significant compared with group A (P<0.05). But a statistically significant difference were not made between the treatment group B and C two group (Z=-0.323, P=0.747, P>0.05) (Table5).Conclusion:1 The 119 patients with acute immune thrombocytopenic purpura all have cutaneous bleeding and (or) petechia. The male/female proportion is 2.22/1. The majority of children are aged 0~2 and 3~4 years. Incidents are frequently in March to May, and the ones in September to November are at least. The history of preceding upper respiratory tract infection, vaccination and abdominal pain (diarrhea) is noted in 33.6%, 7.5% and 4.5%, respectively. Our study reveals that school-age boys are more prone to AITP. The majority of children are in spring at most, and the patients in fall were at least. Incidences are relevant to virus infection and vaccination.2 The median of platelet counts after treatment for three or seven days are risen compared untreatment. This reveals that either methyl-prednisone or methyl-prednisone combined immune globulin for acute immunity thrombocytopenic purpura is valid. 3 At three days or seven days after treatment, the median platelet count and curative efficient between treatment groups and control group is different. This indicates that methyl-prednisone curative effect is not as good as methyl-prednisone combined IVIG.4 At three days and seven days after treated, the median platelet counts and curative efficient of group B and C are not significantly difference. The outcome predicts that the therapeutic effects between the total doses of 1g/kg IVIG and total doses of 2g/kg are the same.