Objective: To explore the efficiency and safety of immune thrombocytopenia（ITP）in children through classification treatment.
Methods: 405 newly diagnosed ITP patients were enrolled in this study from January 1st 2013 to August 31st 2014. The cases were divided into observation group and therapy group according to the initial platelet count of less than 20×10⁹/L or the cases of active bleeding. There were 104 male cases and 76 female cases in observation group with the media platelet count of 46 （20-89）×10⁹/L. They were followed up with a median of 20 months. The therapy group，including 131 males and 94 females with a median platelet count of 11（1-19）×10⁹/L, were followed up by 22 months.
Results: The total curative rate at acute period was 80.44%（181/225）in therapy group with the first line treatment. In observation group, 148 cases（82.22%）reached complete response（CR）or response（R） criteria. 44 patients came into persistent period with an effective rate of 34.09%（15/44）in therapy group. The overall effectiveness over one year was 87.11%（196/255）. In observation group, 32 cases came into persistent period and 13 cases（40.63%）got the CR or R line. After one year of observation, 161 cases （89.44%）reached the CR or R standard. In therapy group, 5 out of 29 patients（17.24%）in chronic period got CR or R. While in observation group, 6 out of 19 cases（31.58%）reached the CR or R standard. The elder children over 10 years had risk factors in response in two groups. There was no severe bleeding or adverse effect or dead cases in this study.
Conclusion: It is reasonable to take platelet count <20×10⁹/L and（or）active bleeding as the dividing line for classification therapy indications. Nearly half of the cases could avoid over therapy and decreased the risk of drugs side effect to improve life quality.
目的: 探讨儿童原发免疫性血小板减少症（ITP）分层治疗的疗效和安全性。
方法: 2013年1月1日至2014年8月31日期间405例≤14岁新诊断ITP患者纳入研究。以PLT<20×109/L或活动性出血为标准分为观察组和治疗组。观察组180例，男104例，女76例，中位基线PLT 46（20~89）×109/L，中位随访时间20（12~31）个月；治疗组225例，男131例，女94例，中位基线PLT 11（1~19）×109/L，中位随访时间22（12~32）个月。
结果: 治疗组患者急性期一线治疗总有效[完全反应（CR）+有效（R）]率为80.44%（181/225）；观察组急性期148例（82.22%）符合CR或R标准。治疗组44例患者进入持续期，持续期内总有效率为34.09%（15/44），发病后1年总有效率为87.11%（196/225）；观察组32例患者进入持续期，13例（40.63%）符合CR或R标准，发病后1年共161例（89.44%）患者符合CR或R标准。治疗组29例进入慢性期，5例（17.24%）患者获CR或R；观察组19例患者进入慢性期，6例（31.58%）符合CR或R标准。年龄≥10岁是影响两组患者1年自愈或治疗无效的高危因素。本组患儿均未观察到严重出血、严重不良反应，无死亡病例。
结论: 以PLT<20×109/L或活动性出血作为儿童ITP分层治疗的指征是安全可行的。