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目的探讨小儿特发性血小板减少性紫癜(ITP)的临床特点及病因分析。方法采用酶联免疫吸附法(ELISA)对ITP患儿进行巨细胞病毒、幽门螺杆菌、EB病毒、支原体、衣原体、呼吸道合胞病毒、单疱病毒、腺病毒的IgM抗体检测;并分析其临床表现、病因、治疗、疗效。结果 135例患儿中病原学检查131例,发现各种病原体抗体呈不同的阳性率;其中135例ITP,急性型占85.2%,慢性型占14.8%,婴幼儿(<3岁)占68.1%,经过随访急性转为慢性ITP 14例(12.2%),转为难治性ITP 12例(8.9%)。62.2%的患儿发病前1～3周有病毒感染史;25.2%的患儿在发病前曾有预防接种史;应用激素和IVIG治疗效果显著,有效率达97.0%。结论本病与病毒感染、预防接种密切相关,其中以HP、CMV感染所占比例高,且绝大多数为急性型,预后良好;激素与IVIG仍为治疗首选。
Objective To investigate the clinical features and etiology of idiopathic thrombocytopenic purpura (ITP) in children. Methods IgM antibodies of cytomegalovirus, Helicobacter pylori, Epstein-Barr virus, mycoplasma, chlamydia, respiratory syncytial virus, herpes simplex virus and adenovirus were detected by enzyme-linked immunosorbent assay (ELISA) Performance, etiology, treatment, efficacy. Results Among the 135 cases, 131 cases were detected by etiological examination and different positive rates of various pathogens were found. Among them 135 cases of ITP accounted for 85.2% of acute cases, 14.8% of chronic cases and 68.1% of infants (<3 years) After follow-up, 14 patients (12.2%) were converted to chronic ITP and 12 patients (8.9%) were converted to refractory ITP. 62.2% of children had a history of viral infection 1-3 weeks before onset; 25.2% of children had a history of vaccination before onset; and hormones and IVIG had a significant effect, with an effective rate of 97.0%. Conclusion The disease is closely related to virus infection and vaccination. Among them, HP and CMV infection account for a high proportion, and most of them are acute type with good prognosis. Hormone and IVIG are still the first choice of treatment.