摘要
目的探讨影响小儿急性特发性血小板减少性紫癜(AITP)发展成慢性特发性血小板减少性紫癜(CITP)的危险因素。方法选择120例AITP患儿进行成组设计的病例对照研究。进行单因素分析后运用多因素非条件Logistic回归模型分析。结果在α=0.05水平,45项指标中单因素分析共筛选出有统计学意义的因素12项,分别是:家住农村、生后非纯母乳喂养、既往有反复呼吸道感染史、病初白细胞数低或正常、发病时年龄大、治疗前病史长、发病时体重大、病初骨髓巨核细胞总数高、原始幼稚巨核细胞数高、颗粒型巨核细胞数高、治疗后血小板开始上升时间长、血小板峰值低。进入非条件Logistic多因素回归模型的变量有6个,按照其对AITP预后影响危险性的大小依次为:治疗前病史(OR=13.46,95%CI3.194～56.730)、发病时年龄(OR=11.90,95%CI2.279～62.085)、病初白细胞数(OR=10.43,95%CI1.947～55.915)、发病时体重(OR=1.10,95%CI1.013～1.194)、病初骨髓巨核细胞数(OR=1.01,95%CI1.005～1.020)、治疗后血小板峰值(OR=0.10,95%CI0.991～0.999)。结论AITP患儿初诊时进行骨髓巨核细胞检查,在治疗过程中观察最大血小板数对预后的判断有重要价值。早诊断、早治疗有利于改善预后。
Objectives To investigate the risk factors for children with acute idiopathic thrombocytopenic purpura（AITP） developing into chronic idiopathic thrombocytopenic purpura（CITP）. Methods One hundred and twenty cases were assigned into case-control study and clinical data were analyzed with mono-factor analysis and multi-factors nonconditional Logistic regression model. Results Mono-factor analysis revealed that twelve of forty five indexes were obviously significant（when α = 0.05 level）. They included living in rural areas,formula feeding history,repeated respiratory infections history,low or normal peripheral white blood cell counts at diagnosis,older age,delayed treatment,high body weight, more megakaryocytes,megakaryoblasts and promegakaryocytes,granular megakaryocyte counts in bone marrow at diagnosis,delayed platelet response time after treatment,low maximal platelet count after treatment. Six indexes were significant with multi-factor stepwise regression analysis. The risk factors included delayed treatment（OR = 13.46,95% CI 3.194 ～ 56.730）,older age（OR = 11.90,95% CI 2.279 ～ 62.085）,peripheral white blood cell counts（OR = 10.43,95% CI 1.947 ～ 55.915）,body weight（OR = 1.10,95% CI 1.013 ～ 1.194）,megakaryocyte counts at diagnosis（OR = 1.01,95% CI 1.005 ～ 1.020）,the maximal platelet count after treatment（OR = 0.10,95% CI 0.991 ～ 0.999）. Conclusions Analyzing the quantity and quality of megakaryocytes with bone marrow examination at diagnosis and reviewing the maximal platelet count after treatment would be critical for predicting the prognosis of AITP. Earlier diagnosis and therapy would be useful to improve the prognosis of AITP children.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2008年第9期792-795,共4页
Journal of Clinical Pediatrics
基金
河北唐山市科学技术研究与发展指导计划项目(No.051346246)
