儿童血小板增多症诊治进展

doi:10.7499/j.issn.1008-8830.2408066

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摘要血小板增多症是儿科的常见疾病，包括原发性和继发性两类。继发性常由感染、贫血、缺铁、外伤或手术等引起，一般无严重血栓形成或出血事件发生。原发因素控制后血小板计数多可恢复正常，临床过程及结局良好。原发性由骨髓增生性肿瘤如真性红细胞增多症、原发性血小板增多症、骨髓纤维化等引起，常伴有造血细胞基因突变。临床表现相较于成人不典型，血栓栓塞及出血事件少见。无症状或症状轻微者一般无需特殊治疗，建议定期监测血小板数值。有血栓形成风险或血小板极度增多者可以考虑使用阿司匹林抗血小板治疗，必要时进行降细胞治疗，但需密切监测药物毒副作用。目前常用的降细胞药物包括羟基脲、干扰素α、阿那格雷等。该文通过介绍儿童血小板增多症的病因及分类、临床表现、诊断及治疗，旨在进一步为临床医师提供治疗决策。

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关键词 ：血小板增多症, 原发性血小板增多症, 血栓栓塞, 羟基脲, 儿童

Abstract：Thrombocytosis is a common condition in children, classified into primary and secondary types. Secondary thrombocytosis is mainly caused by factors such as infection, anemia, iron deficiency, trauma, or surgical intervention, and it typically occurs without severe thrombosis or bleeding events. Platelet counts can return to normal after control of the primary factors, with favorable clinical outcomes. Primary thrombocytosis is mainly caused by myeloproliferative neoplasms such as polycythemia vera, essential thrombocythemia, and myelofibrosis, often accompanied by gene mutations in hematopoietic cells. In children, clinical manifestations are atypical compared to adults, with few thromboembolic or bleeding events. No special treatment is required for patients who are asymptomatic or have mild symptoms, and it is recommended to regularly monitor platelet counts. Antiplatelet therapy with aspirin can be considered for patients at risk of thrombosis or those with extreme thrombocytosis, and cytoreductive therapy can be performed when necessary, but the toxicities and side effects of drugs should be closely monitored. At present, hydroxyurea, interferon-alpha, and anagrelide are commonly used for cytoreductive therapy. This article provides an overview of the etiology, classification, clinical manifestations, diagnosis, and treatment of childhood thrombocytosis to guide healthcare professionals in treatment decisions.

Key words： Thrombocytosis Essential thrombocythemia Thromboembolism Hydroxyurea Child

收稿日期: 2024-08-13

通讯作者: 胡群，女，主任医师，教授。Email：qunhu2013@163.com。 E-mail: qunhu2013@163.com

作者简介: 徐雨婷，女，博士研究生；

引用本文:

徐雨婷,胡群. 儿童血小板增多症诊治进展[J]. 中国当代儿科杂志, 2025, 27(2): 236-241.

XU Yu-Ting,HU Qun. Advances in the diagnosis and treatment of thrombocytosis in children[J]. CJCP, 2025, 27(2): 236-241.

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