405例儿童原发免疫性血小板减少症的分层治疗

OBJECTIVE: To explore the efficiency and safety of immune thrombocytopenia (ITP) in children through classification treatment. METHODS: 405 newly diagnosed ITP patients were enrolled in this study from January 1(st) 2013 to August 31(st) 2014. The cases were divided into observation group and therapy group according to the initial platelet count of less than 20×10(9)/L or the cases of active bleeding. There were 104 male cases and 76 female cases in observation group with the media platelet count of 46 (20–89) ×10(9)/L. They were followed up with a median of 20 months. The therapy group, including 131 males and 94 females with a median platelet count of 11 (1–19) ×10(9)/L, were followed up by 22 months. RESULTS: The total curative rate at acute period was 80.44% (181/225) in therapy group with the first line treatment. In observation group, 148 cases (82.22%) reached complete response (CR) or response (R) criteria. 44 patients came into persistent period with an effective rate of 34.09% (15/44) in therapy group. The overall effectiveness over one year was 87.11% (196/255). In observation group, 32 cases came into persistent period and 13 cases (40.63%) got the CR or R line. After one year of observation, 161 cases (89.44%) reached the CR or R standard. In therapy group, 5 out of 29 patients (17.24%) in chronic period got CR or R. While in observation group, 6 out of 19 cases (31.58%) reached the CR or R standard. The elder children over 10 years had risk factors in response in two groups. There was no severe bleeding or adverse effect or dead cases in this study. CONCLUSION: It is reasonable to take platelet count<20 × 10(9)/L and (or) active bleeding as the dividing line for classification therapy indications. Nearly half of the cases could avoid over therapy and decreased the risk of drugs side effect to improve life quality.