两种原发免疫性血小板减少症出血评分系统的对比研究

OBJECTIVE: To evaluate prospectively the clinical significance of immune thrombocytopenia (ITP) bleeding scale (version 2016 of ITP bleeding scale) recommended in consensus of Chinese experts on diagnosis and treatment of adult primary immune thrombocytopenia (version 2016) by Chinese Medical Association. METHODS: A total of 88 patients were assessed by ITP bleeding scale (version 2016) and ITP specific bleeding assessment tool (ITP-BAT) to analyze the association between bleeding score of ITP bleeding scale (version 2016) and platelet counts, gender, disease stage, also to evaluate interinstrument consistency between two bleeding grading systems. Among 47 newly diagnosed ITP patients treated with high dose dexamethasone, bleeding score of ITP bleeding scale (version 2016) and platelet counts were assessed before treatment, one week and two weeks after treatment, respectively, and the responsiveness of ITP bleeding scale (version 2016) was evaluated. RESULTS: Bleeding score of ITP patients was negatively correlated with platelet counts (r=−0.515, P<0.001). Gender and disease stage had no significant influence on bleeding score (F=4.255, P=0.382; F=5.251, P=0.753). ITP bleeding scale was in excellent agreement with ITP-BAT. Change of bleeding score of 47 ITP patients before and after high dose dexamethasone treatment had significant difference (z=−5.612, P<0.001), also, the same result was observed in patients who didn't get complete response (z=−3.969, P<0.001). Back-to-back scoring consistency of two doctors was 94.4% (k=0.918). It took less time to accomplish ITP bleeding scale (version 2016) than that of ITP-BAT [3 (2–6) min vs 7 (4–13) min, z=−8.213, P<0.001]. CONCLUSION: ITP bleeding scale (version 2016) has good responsiveness, strong assessment consistency, close correlation with ITP-BAT and less time-consuming in clinical application. It can be used as an effective tool of condition judgement, risk assessment and efficacy evaluation of ITP patients.