한국 소아에서 급성면역성혈소판 감소성자반증

Abstract

Purpose: Childhood acute immune thrombocytopenic purpura (ITP) is a benign hematologic disease. Therapy does not affect the natural history of the illness. We evaluated the clinical and laboratory findings, treatment and prognosis of childhood acute ITP in Korea through a retrospective multicenter study. Methods: We analyzed retrospectively the data of 1,829 children with acute ITP through survey of 33 hospitals among 43 hospitals in Korea from Sep. 1992 to Aug. 2001. Results: Male to female ratio was 1.3:1 and the median age at the diagnosis of ITP was 2.9 (0.1∼17) years. Median duration of follow up was 6 months. One hundred and forty nine cases of the total 1,829 patients (8.1%) received no treatment. The initial median platelet count of the non-treated group was 42,500/mm3. Among the 861 cases who were followed up over 6 months, 315 cases (36.6%) progressed into chronic ITP. Associated with this high rate of chronicity of childhood acute ITP patients in Korea, we must consider the fact that acute ITP patients with fast improvement in the first episode tend not to follow up. Considering that fact, the rate of chronicity becomes 17.2% of the 1,829 acute ITP patients. The treated group used many kinds of treatment methods. Intravenous immunoglobulins (IVIG) with or without prednisolone (PD) (67.5%) were the most commonly used regimens. In the group treated with IVIG alone, the platelet count began to rise above 50,000/mm3 at 2.6 days, 100,000/mm3 at 3.7 days and 150,000/mm3 at 4.9 days. Four hundred and twenty two cases of the 1,686 (25.0%) cases followed up after first episode of ITP relapsed. The relapse rate was significantly higher in older patients and in girls than in younger patients and in boys (P＜0.05). The chronicity of ITP statistically increased with age (P＜0.05) and that was the only valuable factor. Conclusion: Despite the fact that childhood acute ITP is a pretty common disaese, there is no agreement on the best treatment method for this disease. The establishment of Korean treatment guideline of childhood acute ITP, based on an analysis of multicenters, seems to be needed.