儿童免疫性血小板减少症的规范治疗与管理

doi:10.12372/jcp.2022.21e1625

摘要/Abstract

摘要：

免疫性血小板减少症（ITP）是儿童时期最为常见的出血性疾病,由多种自身免疫机制介导,以孤立性血小板减少为主要临床特点。儿童ITP通常急性起病,相当比例的患儿可追溯到前驱感染或接种疫苗史,均可使其免疫失耐受,从而导致ITP的发生。儿童ITP异质性较强,目前越来越多的患儿病情反复,一线治疗效果不佳,迁延不愈,导致慢性ITP增加,临床医师应根据每例患儿特点作出相应的个体化治疗,给予合理规范的疾病管理,综合评估治疗效果,减少治疗相关并发症,提高患儿生活质量。

关键词: 免疫性血小板减少症, 规范治疗, 儿童

Abstract:

Immune thrombocytopenia (ITP) is the most common bleeding disorde characterized by isolated thrombocytopenia in children. It is mediated by a variety of autoimmune mechanisms. Children with ITP usually have acute onset. A considerable proportion of patients can be traced back to the history of precursor infection or vaccination, which can make them immune intolerant, resulting in the occurrence of ITP. There is strong heterogeneity of ITP in children. At present, more and more children tend to relapse. The first-line treatment is not effective, and the protracted treatment leads to chronic ITP. Clinicians should make corresponding individualized treatment and give reasonable management according to the characteristics of each child to reduce treatment-related complications and improve the quality of life of children.

Key words: immune thrombocytopenia, standardized treatment, child

张爱军, 刘芹芹, 浦婷. 儿童免疫性血小板减少症的规范治疗与管理[J]. 临床儿科杂志, 2022, 40(2): 81-86.

ZHANG Aijun, LIU Qinqin, PU Ting. Standardized treatment and management of immune thrombocytopenia in children[J]. Journal of Clinical Pediatrics, 2022, 40(2): 81-86.

图/表 1

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出血分级	出血程度
0级	无出血
1级	轻微、微量出血：有少量瘀点（≤100个）和/或≤5个小瘀斑（直径≤3 cm）,无黏膜出血
2级	轻度、少量出血：有较多瘀点（总数>100个）和/或>5个大瘀斑（直径>3 cm）,无黏膜出血
3级	中度、中量出血：有明显的黏膜出血,影响生活
4级	重度、严重出血：黏膜出血导致血红蛋白下降幅度>20 g/L,或怀疑有内脏出血