免疫性血小板减少症患儿严重不良事件分析
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摘要
目的探讨免疫性血小板减少症(ITP)患儿发生严重不良事件(SAE)的高危因素及预后。方法回顾性分析2011年1月至2015年12月重庆医科大学附属儿童医院收治的血小板计数≤20×109/L,合并SAE的ITP患儿的临床特征、高危因素及预后。结果血小板计数≤20×109/L的1 604例ITP患儿中,发生SAE者140例(8.73%),包括严重出血事件(SBE)138例(8.60%),严重感染事件(SIE)2例(0.12%),其中颅内出血6例(0.37%)。鼻衄及月经量增加是血小板计数≤20×109/L的ITP患儿发生SBE最常见的诱因。除青春期女性月经增多外,发生SBE的患儿性别、年龄分布,以及不同病情SBE患儿的病程及血小板计数差异均无统计学意义(P>0.05)。SBE患儿均好转出院,1例SIE患儿因卡氏肺囊虫肺炎死亡。结论鼻衄及月经量增加是儿童ITP发生SBE的高危因素,该类患儿需积极治疗。总体看,ITP患儿发生SAE尤其是颅内出血的概率很低,血小板计数≤20×109/L且无明显出血的患儿可能不需要积极治疗。
Objective To explore the risk factors and prognosis of severe adverse event(SAE)in pediatric immune thrombocytopenia(ITP).Methods Clinical features,risk factors and prognosis of SAE in pediatric ITP patients whose platelet count(PLT)≤20×109/L and hospitalized in Children′s Hospital of Chongqing Medical University from January 2011 to December 2015 were retrospectively analyzed.Results In a total of1 604 pediatric ITP patients with PLT≤20×109/L,SAE was diagnosed in 140 patients(8.73%)which were included 138 patients(8.60%)of severe bleeding event(SBE)and 2 patients(0.12%)of severe infection event(SIE),intracranial bleeding was confirmed in 6 patients(0.37%).Hemorrhinia and menorrhagia were the most common causes for SBE in ITP patients with PLT≤20×109/L.There were no significant differences on gender,age,duration of disease and PLT count for patients with SBE.Patients presented with SBE were improved,and 1 patient with SIE died of pneumocystis carinii pneumonia.Conclusion Hemorrhinia and menorrhagia were risk factors for SBE in pediatric ITP patients,and medicine treatment should be administered in such patients.Incidence of SAE,particularly intracranial bleeding was low,and medicine administration was unnecessary in most pediatric ITP patients.
Objective To explore the risk factors and prognosis of severe adverse event(SAE)in pediatric immune thrombocytopenia(ITP).Methods Clinical features,risk factors and prognosis of SAE in pediatric ITP patients whose platelet count(PLT)≤20×109/L and hospitalized in Children′s Hospital of Chongqing Medical University from January 2011 to December 2015 were retrospectively analyzed.Results In a total of1 604 pediatric ITP patients with PLT≤20×109/L,SAE was diagnosed in 140 patients(8.73%)which were included 138 patients(8.60%)of severe bleeding event(SBE)and 2 patients(0.12%)of severe infection event(SIE),intracranial bleeding was confirmed in 6 patients(0.37%).Hemorrhinia and menorrhagia were the most common causes for SBE in ITP patients with PLT≤20×109/L.There were no significant differences on gender,age,duration of disease and PLT count for patients with SBE.Patients presented with SBE were improved,and 1 patient with SIE died of pneumocystis carinii pneumonia.Conclusion Hemorrhinia and menorrhagia were risk factors for SBE in pediatric ITP patients,and medicine treatment should be administered in such patients.Incidence of SAE,particularly intracranial bleeding was low,and medicine administration was unnecessary in most pediatric ITP patients.
引文
[1]NEUNERT C,LIM W,CROWTHER M,et al.The A-merican society of hematology 2011evidence-based practice guideline for immune thrombocytopenia[J].Blood,2011,117(16):4190-4207.
[2]马洁,吴润晖,陈振萍,等.儿童原发性免疫性血小板减少症疾病转归临床研究[J].临床血液学杂志,2016,30(5):721-724.
[3]中华医学会儿科学分会血液学组,《中华儿科杂志》编辑委员会.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志,2013,51(5):382-384.
[4]BUTROS L J,BUSSEL J B.Intracranial hemorrhage in immune thrombocytopenic purpura:a retrospective analysis[J].J Pediatr Hematol Oncol,2003,25(8):660-664.
[5]VENERI D,FRANCHINI M,RANDON F,et al.Thrombocytopenias:a clinical point of view[J].Blood Transfusion,2009,7(2):75-85.
[6]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:1800-1801.
[7]中华医学会血液学分会止血与血栓学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)[J].中华血液学杂志,2016,37(2):89-93.
[8]GEORGE J N,WOOLF S H,RASKOB G E,et al.Idiopathic thrombocytopenic purpura:apractice guideline developed by explicit methods for the American Society of Hematology[J].Blood,1996,88(1):3-40.
[9]FREDERIKSEN H,MAEGBAEK M L,NORGAARDM.Twenty-year mortality of adult patients with primary immune thrombocytopenia:a Danish population-based cohort study[J].Br J Haematol,2014,166(2):260-267.
[10]王琳,侯明.原发免疫性血小板减少症出血评分系统[J].中华血液学杂志,2015,36(12):1053-1055.
[11]YOUNG M,SCHOONEN W M,LI L,et al.Epidemiology of paediatric immune thrombocytopenia in the General Practice[J].Haematol,2010,149:855-864.
[12]LILLEYMAN J S.Intracranial heamorrhage in idiopathic thrombocytopenic purpura.Paediatric Haematology Forum of the British Society for Haematology[J].Arch Dis Child,1994,71(3):251-253.
[13]British Committee for Standards in Hematology General Hematology Task Force.Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults,children and inpregnancy[J].Br J Heamatol,2013,120(4):574-596
[14]胡群,刘爱国,金润铭,等.儿童原发性免疫性血小板减少症颅内出血的多中心临床研究[J].临床血液学杂志,2013,26(2):171-172.
[15]黎晓红.长程大量应用糖皮质激素的不良反应及防治进展[J].临床合理用药杂志,2016,9(9):174-175.
[16]PARODI E,GIORDANO P,RIVETTI E,et al.Efficacy of combined intravenous immunoglobulins and steroids in children with primary immune thrombocytopenia and persistent bleeding symptoms[J].Blood Transfusion,2014,12(3):340-345.
[17]GUO Y,TIAN X,WANG X E,et al.Adverse effects of immunoglobulin therapy[J].Front Immunol,2018,9(11):1299.
[18]黄月婷,刘晓帆,薛峰,等.重组人血小板生成素治疗41例儿童原发免疫性血小板减少症的疗效及安全性[J].中华血液学杂志,2015,36(6):511-514.
[19]CHANDRA J,RAVI R,SINGH V,et al.Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpura[J].Hematology,2006,11(2):131-133.
[2]马洁,吴润晖,陈振萍,等.儿童原发性免疫性血小板减少症疾病转归临床研究[J].临床血液学杂志,2016,30(5):721-724.
[3]中华医学会儿科学分会血液学组,《中华儿科杂志》编辑委员会.儿童原发性免疫性血小板减少症诊疗建议[J].中华儿科杂志,2013,51(5):382-384.
[4]BUTROS L J,BUSSEL J B.Intracranial hemorrhage in immune thrombocytopenic purpura:a retrospective analysis[J].J Pediatr Hematol Oncol,2003,25(8):660-664.
[5]VENERI D,FRANCHINI M,RANDON F,et al.Thrombocytopenias:a clinical point of view[J].Blood Transfusion,2009,7(2):75-85.
[6]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2002:1800-1801.
[7]中华医学会血液学分会止血与血栓学组.成人原发免疫性血小板减少症诊断与治疗中国专家共识(2016年版)[J].中华血液学杂志,2016,37(2):89-93.
[8]GEORGE J N,WOOLF S H,RASKOB G E,et al.Idiopathic thrombocytopenic purpura:apractice guideline developed by explicit methods for the American Society of Hematology[J].Blood,1996,88(1):3-40.
[9]FREDERIKSEN H,MAEGBAEK M L,NORGAARDM.Twenty-year mortality of adult patients with primary immune thrombocytopenia:a Danish population-based cohort study[J].Br J Haematol,2014,166(2):260-267.
[10]王琳,侯明.原发免疫性血小板减少症出血评分系统[J].中华血液学杂志,2015,36(12):1053-1055.
[11]YOUNG M,SCHOONEN W M,LI L,et al.Epidemiology of paediatric immune thrombocytopenia in the General Practice[J].Haematol,2010,149:855-864.
[12]LILLEYMAN J S.Intracranial heamorrhage in idiopathic thrombocytopenic purpura.Paediatric Haematology Forum of the British Society for Haematology[J].Arch Dis Child,1994,71(3):251-253.
[13]British Committee for Standards in Hematology General Hematology Task Force.Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults,children and inpregnancy[J].Br J Heamatol,2013,120(4):574-596
[14]胡群,刘爱国,金润铭,等.儿童原发性免疫性血小板减少症颅内出血的多中心临床研究[J].临床血液学杂志,2013,26(2):171-172.
[15]黎晓红.长程大量应用糖皮质激素的不良反应及防治进展[J].临床合理用药杂志,2016,9(9):174-175.
[16]PARODI E,GIORDANO P,RIVETTI E,et al.Efficacy of combined intravenous immunoglobulins and steroids in children with primary immune thrombocytopenia and persistent bleeding symptoms[J].Blood Transfusion,2014,12(3):340-345.
[17]GUO Y,TIAN X,WANG X E,et al.Adverse effects of immunoglobulin therapy[J].Front Immunol,2018,9(11):1299.
[18]黄月婷,刘晓帆,薛峰,等.重组人血小板生成素治疗41例儿童原发免疫性血小板减少症的疗效及安全性[J].中华血液学杂志,2015,36(6):511-514.
[19]CHANDRA J,RAVI R,SINGH V,et al.Bleeding manifestations in severely thrombocytopenic children with immune thrombocytopenic purpura[J].Hematology,2006,11(2):131-133.