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目的分析比较婴儿与1岁以上儿童免疫性血小板减少症(immune thrombocytopenia,ITP)的临床特点及疗效。方法收集2008年1月至2012年12月在郑州大学第三附属医院首次诊断,治疗选用激素和免疫球蛋白的ITP患儿224例。按年龄分为婴儿组(≤12个月)和1岁以上儿童组(>12个月),回顾性分析比较两组患儿的性别构成、出血表现、病原血清学检查结果及疗效等临床资料。应用SPSS17.0软件进行统计学处理。结果①两组中均以男性患儿为主,性别比较差异无统计学意义(χ2=0.767,P>0.05);②婴儿组鼻衄发生率低于1岁以上儿童组,差异有统计学意义(χ2=7.648,P<0.05),婴儿组粪潜血发生率高于1岁以上儿童组,差异有统计学意义(χ2=5.799,P<0.05);③大部分(76.8%)患儿有前驱感染史,疫苗相关ITP均发生在婴儿组;婴儿组巨细胞病毒抗体(CMV-IgM)阳性率明显高于1岁以上儿童组,差异有统计学意义(χ2=16.653,P<0.05);④不论采用激素冲击疗法或激素联合免疫球蛋白治疗,婴儿组短期疗效均好于1岁以上儿童组;婴儿组慢性ITP发生率明显低于1岁以上儿童组,差异有统计学意义(χ2=16.40,P<0.05)。结论与1岁以上儿童相比,疫苗接种是婴儿ITP的重要诱因,CMV感染可能与婴儿ITP密切相关,婴儿ITP易出现消化道粘膜出血、对治疗反应好、慢性ITP发生率低。对于儿童ITP,需重视对出血严重程度的认识,需行骨髓穿刺,需从患儿病情出发,综合考虑药物副作用、生存质量、经济因素等,选择合理方案,避免过度治疗。
Objective To compare and analyze the clinical features and therapeutic effects of immune thrombocytopenia (ITP) in infants and children over 1 year old. Methods Totally 224 children with ITP who were diagnosed and treated with hormones and immunoglobulin at the Third Affiliated Hospital of Zhengzhou University from January 2008 to December 2012 were collected. According to their age, they were divided into infants (≤12 months) and children over 1 year (> 12 months). The clinical data of gender composition, hemorrhagic manifestations, pathogen serological test results and curative effect were retrospectively analyzed . Application SPSS17.0 software for statistical analysis. Results ① There was no significant difference in sex between male and female children in both groups (χ2 = 0.767, P> 0.05). ② The incidence of nasal discharge in infants was lower than that of children aged 1 year and above, the difference was statistically significant (χ2 = 7.648, P <0.05). The incidence of fecal occult blood in infants was higher than that in children over 1 year old (χ2 = 5.799, P <0.05); ③ The majority of children (76.8% The positive rate of CMV-IgM in infant group was significantly higher than that in children over 1 year old (χ2 = 16.653, P <0.05). No matter using hormonal shock therapy or hormonal combined immunoglobulin therapy, the short-term curative effect of infant group was better than that of children over 1 year old. The incidence of chronic ITP in infants was significantly lower than that of children over 1 year old (χ2 = 16.40 , P <0.05). Conclusion Compared with children over 1 year old, vaccination is an important cause of ITP in infants. CMV infection may be closely related to infant ITP. Infantile ITP is prone to gastrointestinal mucosal hemorrhage. The response to treatment is good, and the incidence of chronic ITP is low. For children with ITP, we need to pay attention to the understanding of the severity of bleeding, the need for bone marrow puncture, starting from the patient’s condition, taking into account the drug side effects, quality of life, economic factors, choose a reasonable plan to avoid over-treatment.