免疫性血小板减少症合并心肌损伤患儿临床分析

doi:10.12372/jcp.2022.21e1231

Abstract

Abstract:

Objective To investigate the clinical characteristics of immune thrombocytopenia (ITP) children with myocardial injury. Methods Newly diagnosed ITP children hospitalized in Wuhan Children's Hospital from December 2018 to April 2020 were retrospectively analyzed. According to the complication, children were divided into the non-myocardial injury group and myocardial injury group. The clinical characteristics, laboratory examination and prognosis of the two groups were compared. Results In this study, 360 newly diagnosed ITP children were analyzed, including 240 boys and 120 girls, with a median age of 3.0 (2.0~6.0) years. Of the 360 children, 294 were in the non-myocardial injury group and 66 were in myocardial injury group. Compared with the non-myocardial injury group, levels of CK, CK-MB and LDH-L in myocardial injury group were higher, the proportions of girls and younger children were higher, the values of thromboelastogram-maximal amplitude were larger, the proportions of children with PLT <10×10 ⁹/L / bleeding score >3 were lower, the counts of platelet, white blood cells, CD8 ⁺T cells and NK cells were higher, the levels of IgE were lower. These differences were statistically significant (P<0.05). Log-rank analysis showed that platelet recovery of the myocardial injury group was slower than the non-myocardial injury group after treatment (P<0.001). Conclusion It is not rare for ITP children with myocardial injury. Although platelet recovery is slower at initial diagnosis, myocardial injury does not promote the progression of newly diagnosed ITP to persistent ITP.

Key words: immune thrombocytopenia, myocardial injury, coagulation function, child

QI Shan-shan, WANG Zhuo, LI Jianxin, CHEN Jingpei, YANG Shijia, CHEN Zhi, SUN Ming, CHEN Yan, XIONG Hao. Analysis of clinical characteristics of immune thrombocytopenia children with myocardial injury[J].Journal of Clinical Pediatrics, 2022, 40(2): 101-106.

Figures/Tables 5

References 29

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项目	心肌损伤组(n=66)	非心肌损伤组(n=294)	统计量	P
性别男[n(%)]	24(36.4)	216(73.5)	χ²=33.40	<0.001
年龄[M(P₂₅~P₇₅)]/岁	1.0(0.4~2.0)	3.0(0.8~5.0)	Z=2.19	0.029
肝肿大[n(%)]	6(9.1)	54(18.4)	χ²=3.34	0.068
脾肿大[n(%)]	6(9.1)	12(4.1)	χ²=2.85	0.092
接受糖皮质激素治疗[n(%)]	24(36.4)	114(38.8)	χ²=0.13	0.716
CK[M(P₂₅~P₇₅)]/U·L^-1	59.0(27.0~131.0)	84.0(59.5~128.5)	Z=2.16	0.030
CK-MB[M(P₂₅~P₇₅)]/U·L^-1	91.0(68.0~156.0)	33.0(25.0~49.0)	Z=9.91	<0.001
LDH-L[M(P₂₅~P₇₅)]/U·L^-1	414.0(279.0~504.0)	300.0(234.8~336.0)	Z=4.16	<0.001

凝血指标	心肌损伤组(n=66)	非心肌损伤组(n=294)	统计量	P
PLT[M(P₂₅~P₇₅)]×10⁹·L^-1	21.0(13.0~38.0)	9.0(3.0~21.0)	Z=2.39	0.017
PLT<10×10⁹·L^-1 [n(%)]	6(9.1)	156(53.1)	χ²=42.11	<0.001
血栓弹力图检测(x±s)
凝血反应时间/min 纤维蛋白生成速率/deg 最大振幅/mm	6.8±1.8	7.2±2.0	t=0.74	0.491
	50.5±8.8	47.1±12.2	t=1.03	0.369
	37.0±7.4	28.1±13.2	t=2.89	0.010
出血评分>3分[n(%)]	6(9.1)	90(30.6)	χ²=12.77	<0.001
巨核细胞成熟障碍[n(%)]¹⁾	6(25.0)	30(17.9)	χ²=0.70	0.406

免疫指标	心肌损伤组(n=66)	非心肌损伤组(n=294)	统计量	P
WBC×10⁹·L^-1	9.2(7.3~25.3)	7.8(6.1~9.4)	Z=4.67	<0.001
NEU×10⁹·L^-1	2.3(1.9~3.3)	2.8(1.7~5.1)	Z=1.64	0.101
LYM×10⁹·L^-1	6.3(3.1~10.9)	3.4(2.1~5.3)	Z=6.04	<0.001
MONO×10⁹·L^-1	0.6(0.4~0.8)	0.7(0.4~0.7)	Z=0.29	0.769
CD3⁺ T淋巴细胞×10⁹·L^-1	3.6(1.8~5.8)	2.9(1.9~3.8)	Z=1.58	0.112
CD4⁺ T淋巴细胞×10⁹·L^-1	1.2(0.5~2.7)	1.6(0.9~2.3)	Z=0.20	0.845
CD8⁺ T淋巴细胞×10⁹·L^-1	1.1(0.8~2.8)	1.0(0.6~1.5)	Z=3.30	0.010
NK细胞×10⁹·L^-1	0.5(0.3~0.8)	0.3(0.2~0.6)	Z=5.14	0.001
B淋巴细胞×10⁹·L^-1	0.9(0.4~1.4)	0.8(0.4~1.3)	Z=1.45	0.147
Treg×10⁹·L^-1	0.2(0.1~0.3)	0.2(0.1~0.3)	Z=1.42	0.157
lgG/g·L^-1	7.4(6.3~8.3)	8.1(6.5~8.9)	Z=1.63	0.103
lgA/g·L^-1	0.6(0.4~1.0)	0.7(0.4~1.0)	Z=0.91	0.363
lgM/g·L^-1	0.8(0.7~1.0)	0.9(0.7~1.2)	Z=1.67	0.094
lgE/g·L^-1	15.1(4.7~40.5)	40.1(14.7~79.3)	Z=4.51	<0.001
补体C3/g·L^-1	1.1±0.2	1.1±0.3	t=1.26	0.573
补体C4/g·L^-1	0.2(0.1~0.4)	0.2(0.1~0.3)	Z=1.55	0.121

治疗天数	外周血血小板升高倍数		统计量	P
治疗天数	心肌损伤组(n=66)	非心肌损伤组(n=294)	统计量	P
第1天	1.4±0.6	1.5±0.8	t=1.45	0.151
第2天	3.8±1.7	4.3±2.8	t=1.70	0.090
第3天	8.59(0.43~17.79)	18.39(1.67~30.05)	Z=3.16	0.002
第4天	9.59(1.24~18.77)	23.04(2.18~46.94)	Z=3.61	<0.001

Analysis of clinical characteristics of immune thrombocytopenia children with myocardial injury

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