| Background of the studyIdiopathic thrombocytopenic purpura (ITP) is a kind of immune-mediated thrombocytopenia syndrome. It is the most common hemorrhagic disease in clinic, with the clinical features of hematostaxis of dermal mucous, decrease of PLT, longer time of bleeding and defective blood clotretraction. Patients who are not very sick can remain relatively asymptomatic, while seriously ill patients can have extensive spontaneous hemorrhage, hematoma or continuing bleeding, or even threatening bleeding like intractanial hemorrhage, massive bleeding of the alimentary canal and urogenital tract. For now, adrenal glucocorticoid is the first choice for ITP. But for those patients who are hormon-dependent or forbidden to use hormone or fail to respond to hormonotherapy, splenectomy is an effective treatment. It is likely to trigger hemorrhagic complication, thrombocomplication and infectious complication like overwhelming postsplenectomy infection (OPSI) after splenectomy. Therefore, the analysis of the factors that affect splenectomy of ITP prognosis does not only play an important role in conducting preoperative evaluation, but is also crucial to the prognostic judgement of the therapist based on correlated factors, to intervene early the defective prognosis so as to avoid massive bleeding after the surgery.ObjectivesTo discuss the factors that affect splenectomy as a treatment of ITP prognosis.Data and MethodsComputer retrieval was used in this thesis. The author searched the China Journal Full-text Database, Chinese Science and Technology Periodical Database, Ten Thousand Side Periodicals and the Dissertation Database, and the Chinese Biomedicine Literature Database comprehensively. Besides, retrospective retrieval and manual retrieval were also used. From the domestic public theories and the dissertations dating from January,1991 to December,2010, the clinical materials and information about the factors that affect splenectomy as a treatment of ITP prognosis were collected. The author incorporated the data into the original study and evaluated their quality, extracted the information and checked them over. Then according to the inclusion and exclusion standards, documents which were inappropriate for the purposes and standards of the study were removed.RavMan 4.2 provided by Cochrane was used for Meta Analysis. The author selected fixed or random model according to the literature results of heterogeneity test. Odds Ratio (OR) and 95% Confidence Interval (CI) were estimated in the dissertation.Results23 studies including a total number of 1190 cases of patients meet the inclusion criteria, with which 966 of them belong to the valid group, and the other 224 belong to the invalid one. All of the 23 studies were retrospective studies.OR and 95% CI were as follows:1. Female gender, OR=1.42, and 95%CI=[0.74,2.76], p=0.29, the difference was not statistically significant;2. When having the operation, Age< 40 years, OR=5.98, and 95%CI=[1.47,24.26], p=0.01, the result was statistically significant;3. Cause of the disease before surgery< 1 year, OR=1.33,95%CI=[0.52,3.35], p=0.55, the result was not statistically significant;4. Before surgery, PLT>20×109/L, OR=2.55,95%CI=[1.08,6.04], Z=2.13, p=0.03, the result was statistically significant;5. Responding to steroids before surgery, OR=2.01,95%CI=[1.27,3.20], Z=2.95, p=0.003, the result was statistically significant;6. Normal or growing quantity of megakaryocyte number. OR= 11.34, 95%CI=[1.54,83.71], Z=2.38, p=0.02, the result was statistically significant;7. PAIgG is higher than the normal level, OR=1.67,95%CI=[0.69,4.03], Z=1.14, p=0.25, the result was not statistically significant;8. LS, OR=1.06,95%CI=[0.35,3.15], p=0.92, the result was not statistically significant;9. PLT increases to 100×109/L in the three days after surgery, OR=5.65, 95%CI=[2.28,13.98], Z=3.74, p=0.0002, the result was statistically significant;10. The peak value of PLT after surgery is more than 400×109/L, OR=4.78, 95%CI=[1.94,11.78], Z=3.40, p=0.0007, the result was statistically significant.Conclusion1. In the present China, better factors that affect the splenectomy of ITP prognosis are mainly listed as the follows:age<40 years when having the operation, PLT>20×109/L before surgery, responding to steroids before surgery, normal or growing quantity of megakaryocyte number, PLT increasing to 100×109/L in the three days after surgery, the peak value of PLT after surgery is more than 400×109/L.2. Using OR as an effective index (see Appendix 1). The phenomenon of PLT> 20×109/L and responding to steroids before surgery is moderately associated with valid splenectomy of ITP; The phenomenon of Age<40 years when having the operation, PLT increasing to 100×109/L in the three days after surgery and the peak value of PLT after surgery>400x109/L is highly correlated with valid splenectomy of ITP; The normal or growing quantity of megakaryocyte number is strongly connected with valid splenectomy of ITP.3. For ITP patients, the basic information about their ages, reactions to hormonotherapy, PLT, megakaryocyte number examined by bone marrow aspiration should be understood in detail before splenectomy. Doctors conduct preoperative assessment based on the above data and evaluate the curative effect of microsurgery. Patients who are qualified can have a laparoscopic splenectomy. After the splenectomy, the rising velocity and peak value of patients'PLT should be examined in order to predict the effect and give symptomatic treatment.4. Because all of the 23 studies were retrospective studies, and maybe there was some omission in the design, some kinds of bias could arise. As a result, further conclusions need to be drawn through a number of well-designed, large sample prospective studies. |
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