Analysis of risk factors for the chronicity of immune thrombocytopenia in children
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摘要:
目的：分析儿童原发免疫性血小板减少症（immune thrombocytopenia，ITP）慢性化的危险因素，为临床早期判断疾病转归及治疗提供依据。方法：选取2019年1月—2021年12月在南京医科大学附属淮安第一医院儿科诊断为ITP的161例住院患儿为研究对象，并随访1年以上，按照病程长短分为非慢性ITP组（84例）及慢性ITP组（77例）。多因素Logistic回归分析慢性ITP的独立危险因素；通过受试者工作特征（receiver operating characteristic，ROC）曲线、校准曲线和临床决策曲线（decision curve analysis，DCA）评估模型的效能。结果：①慢性ITP发生的独立危险因素包括年龄、辅助性T细胞（helper T cell，Th）/杀伤性T细胞（killer T cell，Tc）、血清胱抑素C和血清C3（P＜0.05）；②年龄、Th/Tc、血清胱抑素C、血清C3及四者联合预测慢性ITP 发生的 ROC 曲线下面积分别为 0.725（95％CI：0.647~0.804）、0.741（95％CI：0.665~0.817）、0.706（95％CI：0.626~0.785）、0.635 （95％CI：0.550~0.720）、0.853（95％CI：0.794~0.911）；③Calibration校准曲线接近理想曲线；④DCA曲线显示预测模型在0.10~ 0.85概率范围内的表现更好。结论：年龄、Th/Tc、血清胱抑素C和血清C3是儿童慢性ITP发生的独立影响因素，上述指标联合对预后有更好的预测价值。
Abstract:
Objective：To analyze risk factors of chronic childhood immune thrombocytopenia（ITP），and to provide basis for early judging the prognosis and treatment of ITP. Methods：A total of 161 inpatients diagnosed with ITP in the Pediatrics Department of the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University between January 2019 and December 2021 were selected as the research subjects，and they were followed up for more than one year. According to the course of the disease，they were divided into non-chronic ITP group（84 cases）and chronic ITP group（77 cases）. Multivariate logistic regression analysis was conducted to analyze the independent risk factors of chronic ITP. The efficacy of the model was evaluated by receiver operating characteristic（ROC）curve， calibration curve and decision curve analysis（DCA）. Results：①Independent risk factors for chronic ITP included age，helper T cell （Th）/killer T cell（Tc），serum cystatin C and serum C3（P＜0.05）. ②The areas under the ROC curves to predict chronic ITP by age， Th/Tc，serum cystatin C and serum C3 and their combination were 0.725（95％CI：0.647~0.804），0.741（95％CI：0.665~0.817），0.706 （95％CI：0.626~0.785），0.635（95％CI：0.550~0.720），0.853（95％CI：0.794~0.911），respectively. ③The calibration curve is close to the ideal curve. ④The DCA curves showed a better performance of the prediction model in the 0.10~0.85 threshold probability range. Conclusion：Age，Th/Tc，serum cystatin C and serum C3 are independent influencing factors in children with chronic ITP，and their combination shows a better predictive value for the prognosis.
