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目的分析婴儿期特发性血小板减少性紫癜(ITP)的诱因、临床特点、实验室资料、治疗反应和转归,为临床治疗和预后评估提供依据。方法 2007年1月-2008年6月共收治32例ITP住院婴儿,男20例,女12例,中位年龄5个月,对其临床特征、治疗、转归进行回顾性分析。结果 32例中14例有前驱感染,5例发病前2周～3个月内有过疫苗预防接种史。病程<3 d者25例,3～7 d者5例,>7 d者2例。主要表现为不同程度的皮肤、黏膜出血(包括消化道出血)。治疗以地塞米松单独或联合静脉用人血丙种球蛋白冲击,并以适量泼尼松短期维持。出血停止并且血小板计数恢复正常<3 d者16例,3～7 d者14例,>7 d者2例。经地塞米松冲击治疗的21例中,3例停药后又复发,再次给予联合冲击治疗,均在1周内恢复。中位随访时间12个月,无1例转为慢性或难治性病例。结论婴儿ITP是一组预后良好的疾病,地塞米松单独或联合静脉用人血丙种球蛋白冲击是有效治疗。免疫接种引起的ITP预后亦佳。
Objective To analyze the causes, clinical characteristics, laboratory data, treatment response and prognosis of idiopathic thrombocytopenic purpura (ITP) in infancy and provide the basis for clinical treatment and prognosis evaluation. Methods A total of 32 ITP hospitalized infants, including 20 males and 12 females, were enrolled in our hospital from January 2007 to June 2008, with a median age of 5 months. The clinical features, treatment and outcome were retrospectively analyzed. Results Of the 32 cases, 14 cases had prodromal infection and 5 cases had vaccination history within 2 weeks to 3 months before onset. 25 cases of course of disease <3 days, 5 cases of 3 ~ 7 days, 2 cases> 7 days. Mainly for varying degrees of skin, mucous membrane bleeding (including gastrointestinal bleeding). Treatment with dexamethasone alone or in combination with intravenous human blood gamma globulin impact, and moderate amounts of prednisone to maintain. Bleeding stopped and platelet count returned to normal within 3 days in 16 cases, 3 to 7 days in 14 cases,> 7 days in 2 cases. Among 21 cases treated with dexamethasone, 3 cases relapsed after stopping the treatment and were given combined shock therapy again, all within 1 week. The median follow-up time was 12 months, and none of the patients turned to chronic or refractory cases. Conclusion Infant ITP is a well-prognosed disease with dexamethasone alone or in combination with intravenous administration of human gamma-globulin for effective treatment. ITP vaccination caused by the prognosis is also good.