Prognostic factors in immune thrombocytopenia in children / 中华实用儿科临床杂志

ABSTRACT

Objective To explore the prognostic relationship between initial absolute lymphocyte count(ALC) of peripheral blood and primary immune thrombocytopenia(ITP)in children,in order to provide basis for judging the prognosis and treatment of ITP in children. Methods Clinical data of 166 children with primary ITP in children admi_tted at the Affiliated Hospital of xuizhou medical University from January 2014 to march 2018 were analyzed retrospec_tively,and they were followed up by clinic and telephone,the prognostic factors( gender,age,ethnicity,inducement, bleeding,initial ALC,platelet count and treatment)were statistically analyzed,and the relationship between ALC of pe_ripheral blood and the prognosis of children with ITP was observed. Results Of 166 children with ITP,89 cases (53. 6%)had remission within 3 months,18 cases(10. 8%)within 3_12 months,20 cases(12. 0%)within 1_4 years,a total of 39 cases(23. 5%)were refractory(no remission in 1_10 years),the remission rate within 1 year was 64. 5%,the total remission rate was 76. 4%. ALC of remission cases was(4. 58 ± 2. 87)×109/L within 3 months, (4. 47 ± 2. 04)×109/L within 3 _12 months,and(2. 86 ± 1. 61)×109/L within 1 _ 4 years. Thirty_nine cases (23. 5%)were refractory(no remission in 1_10 years),ALC of them was(2. 07 ± 0. 98)×109/L,and there were significant differences among different groups( F = 12. 06,P <0. 01 ). Univariate analysis showed that age( F =27. 28),pre_morbidity history of infection and vaccination history(χ2 = 9. 31),initial ALC( F=12. 06)at initial diagnosis were related with the prognosis of children with ITP(all P<0. 05). multivariate analysis showed that the his_tory of infection before onset,the history of vaccination(95%CI0. 19 to 1. 51,P <0. 05)and initial ALC(95%CI_0. 64 to _0. 23,P<0. 001)at the time of initial diagnosis were independent factors affecting the prognosis of children with ITP. The receivers operating characteristic(ROC)was drawn with the development of chronic disease(course >12 months)as state variable and ALC as test variable. The area under curve(AUC)was 0. 765(P<0. 05),cut_off point was 3. 925×109/L,sensitivity was 0. 542,and specificity was 0. 966. Conclusions Initial ALC can be used as one of the prognosis index of ITP in children,and low ALC is the risk signal for chronic development of ITP in children.