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目的:通过对初次发病的儿童原发性免疫性血小板减少症(ITP)临床资料收集及疾病转归随访,分析儿童ITP的临床特点及预后,探讨影响预后的相关因素。方法:通过前瞻性、阶段性收集2005-02-2011-08北京儿童医院血液肿瘤中心住院的初发ITP儿童的临床资料,并对其以门诊及电话的方式进行随访,了解儿童ITP的临床特点及疾病转归情况。通过多因素回归分析及组间比较,了解可能影响疾病预后的临床指标。结果:共收集到469例初发ITP患儿的临床资料,随访时间截止到2012年4月。442例随访时间超过6个月,6个月内缓解346例,6~12个月内缓解35例,12个月后缓解24例,2年及5年预期缓解率分别为87.90%和94.70%;复发18例,其中13例在缓解后1年内复发,10例在复发1年内再次缓解,2年及5年预期复发率分别为4.20%和6.10%。影响缓解的相关因素为诊断前病程及年龄;影响复发的危险因素为年龄、诊断前病程和前驱感染史。结论:儿童ITP缓解率高,将近75%的患儿6个月内缓解,5年预期缓解率可超过90%,诊断前病程较短及发病年龄小的患儿缓解率高;儿童ITP复发率低,2~5年预期复发率在5%左右,发病年龄大、诊断前病程长及有前驱感染史的患儿复发风险大。
OBJECTIVE: To analyze the clinical features and prognosis of children with ITP by collecting the clinical data of ITP and the prognosis of disease in children with primary onset, and to explore the related factors that influence the prognosis. Methods: The clinical data of newly diagnosed ITP children hospitalized at Beijing Children’s Hospital Hematological Oncology Center were collected from 2005-02-2011-08 in a prospective and phased manner. The clinical features of ITP in children were followed up by means of outpatient and telephone interview And the outcome of the disease. Through multivariate regression analysis and comparison between groups to understand the clinical indicators that may affect the prognosis of the disease. Results: A total of 469 cases of ITP were collected in children with clinical data, follow-up until April 2012. 442 cases were followed up for more than 6 months, 346 cases were relieved within 6 months, 35 cases were remitted within 6 ~ 12 months and 24 cases remitted after 12 months. The expected remission rates at 2 years and 5 years were 87.90% and 94.70% ; 18 cases were relapsed, of which 13 cases relapsed within 1 year after remission, 10 cases re-relieved within 1 year after recurrence, and the expected recurrence rates at 2 years and 5 years were 4.20% and 6.10% respectively. The influencing factors of mitigation were the pre-diagnosis course of disease and the age; the risk factors of recurrence were age, pre-diagnosis course and pre-infection history. Conclusion: Children with high ITP rate of remission, nearly 75% of children with remission within 6 months, five-year expected remission rate of more than 90%, a short period of time before diagnosis and a small age of onset of children with high remission rate; children with ITP recurrence rate Low, 2 to 5 years is expected to relapse rate of about 5%, age of onset, long duration of diagnosis and a history of pre-infection in children with a high risk of recurrence.