Chronic idiopathic thrombocytopenic purpura in adult Chinese patients: a retrospective single-centered analysis of 1791 cases

摘要

Background Adult chronic idiopathic thrombocytopenic purpura (ITP) is a common hematologic disease characterized by persistent thrombocytopenia. So far, there were only a few reports on adult Chinese patients with chronic ITP. This study aimed at defining the treatment outcome and prognostic factors for chronic ITP based on a large cohort of Chinese patients followed up for over 25 years at a single center. Methods The medical records of 1791 patients aged 14 years or older who were diagnosed as having chronic ITP at our hospital from 1974 to 1999 were retrospectively analyzed. Results The female-to-male ratio was 2: 1, with a median age of 34 years (ranging from 14 to 80 years) , median platelet count of 38 x 10~9/L [range (1 -99) x 10 /L], and median follow-up of 36 months (range 1 -220 months). Steroids were used in 689 patients, among them 209 (30.3%) achieved complete remission (CR). A splenectomy was performed in 124 patients, and response to steriod pre-splenectomy was not available in 14 patients. The CR rate after a splenectomy was lower in steroid nonresponders (29 of 90, 32.2% ) than in those who relapsed after successful steroid treatment (12 of 20, 60.0% ) ( P < 0.05 ) . In comparison with patients negative for antinuclear antibody (ANA), those who were ANA positive had similar responses to steroids, but a significantly shorter remission period after a splenectomy (P < 0.01). Conclusions Adult Chinese chronic ITP patients can have long-term remission after steroid therapy and splenectomies. Primary steroid refractoriness is a prognostic factor predicting poor subsequent response to a splenectomy.