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目的:观察小于12月婴儿及中等年龄(大于1岁小于8岁)免疫性血小板减少症(ITP)患儿的临床表现,为正确认识及治疗儿童ITP提供临床依据。方法:分析2013年10月至2015年10月我院收治的免疫性血小板减少症患儿124例,其中婴儿组ITP患儿61例,中等年龄组患儿63例,统计两组性别构成,体重指数,发病季节,前驱感染史,预防接种史,初诊血小板计数、血小板相关抗体(PA Ig)检测阳性率,病毒学检测阳性率以及近期疗效和随访结果。结果:两组性别构成、体重指数无显著差异(P>0.05);儿童ITP发病无明显季节性;39.3%婴儿起病前有诱因,疫苗接种者占8.2%;58.7%中等年龄组起病前有诱因,无预防接种为诱因者。病毒检测阳性率婴儿组显著低于中等年龄组(P<0.05)。两组血小板相关抗体(PA Ig)检测阳性率均较低,差异无显著性(P>0.05)。婴儿组初诊血小板计数为(8.32±6.48)×109/L,显著低于中等年龄组[(11.45±8.30)×109/L](P<0.05);住院天数为(6.00±0.68)d,显著低于中等年龄组(7.00±1.02)d,差异有统计学意义(P<0.05);两组近期治疗总体有效率达96.8%,婴儿组近期疗效尤其是完全缓解率显著高于中等年龄组(P<0.05);长期随访婴儿组未见持续不缓解病例。两组出血严重程度均较低,尚未发现颅内出血病例。结论:儿童ITP总体疗效良好,尤其是小于12月龄婴儿,其临床出血表现程度轻微,疗效显著,预后好,对此类患儿,应避免过度检查及用药,加强沟通以避免家长的过度恐慌。同时应继续加强儿童ITP发病机制的研究。
OBJECTIVE: To observe the clinical manifestations of children with immunothrombocytopenia (ITP) less than 12 months of infancy and of medium age (over 1 year and under 8 years old), so as to provide a clinical basis for correctly understanding and treating ITP in children. Methods: From October 2013 to October 2015, 124 children with immune thrombocytopenia were admitted to our hospital, including 61 infants with ITP and 63 infants with middle age. The gender composition, body weight Index, season of onset, history of pre-infection, vaccination history, initial diagnosis of platelet count, PA Ig test positive rate, virological test positive rate, and recent efficacy and follow-up results. Results: There were no significant differences in sex composition and body mass index between the two groups (P> 0.05). There was no seasonal seasonal distribution of ITP in children, and 39.3% of infants were induced before vaccination. Vaccination accounted for 8.2% There are incentives, no vaccination as a inducement. The positive rate of virus detection in infants was significantly lower than that in middle age group (P <0.05). The positive rates of platelet-associated antibody (PA Ig) were lower in both groups (P> 0.05). The initial count of platelet count in infants was (8.32 ± 6.48) × 109 / L, which was significantly lower than that in middle age group [(11.45 ± 8.30) × 109 / L] (P <0.05) (7.00 ± 1.02) d, the difference was statistically significant (P <0.05); the overall effective rate of the two groups was 96.8% in the short term, and the immediate effect and complete remission rate of the infant group was significantly higher than that of the middle age group P <0.05); no long-term follow-up infants did not relieve cases. The severity of bleeding in both groups was low and no intracranial hemorrhage was found. Conclusion: The overall efficacy of ITP in children is good, especially in infants less than 12 months of age. The clinical bleeding performance is mild, the curative effect is significant and the prognosis is good. In this kind of children, over-examination and medication should be avoided and communication should be strengthened to avoid excessive fear of parents . At the same time should continue to strengthen the study of children’s pathogenesis of ITP.