【作者】 李慧；

【导师】 刘霆；

【作者基本信息】 四川大学 ， 内科学， 2004， 硕士

【摘要】 目的 特发性血小板减少性紫癜(Idiopathic Thrombocytopenic Purpura,ITP)是一个因免疫机制参与而使血小板生成减少和破坏增多的疾病,分为急性和慢性。本实验的目的是了解幽门螺杆菌(H.pylori,Hp)在CITP患者中的发病率,并进一步探讨对于伴发Hp感染的慢性血小板减少性紫癜(CITP)患者采用根除Hp治疗,在恢复血小板数量方面是否存在显著性差异,进而了解Hp感染在CITP的发生、发展中的作用,为临床上更加有效治疗该类疾病,提供实验依据与合理用药指导。 材料和方法 本实验研究了从2003年10月～2004年3月四川大学华西医院门诊或住院确诊的CITP的患者,通过检测患者粪便中Hp抗原成分(HpSA)和外周血中Hp IgG抗体,确定有Hp感染的CITP患者共20例,对这类病人给予肾上腺糖皮质激素联用根除Hp治疗(或单用根除Hp治疗),通过监测治疗后血小板计数、血小板相关抗体(PAIgG)滴度,HpSA的变化来比较肾上腺糖皮质激素联用根除Hp治疗(或单用根除Hp治疗)与单用肾上腺糖皮质激素(或其他治疗)是否存在显著差异。两组血小板数量变化的统计分析采用t检验,P值低于0.05认为有意义。更多还原

【Abstract】 Objective Idiopathic thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count and mucocutaneous bleeding. The causes are destruction of platelets in the reticuloendothelial system mediated by platelet-bound autoantibodies and reduction of platelets produced from megakaryocytes. ITP can be classified as acute ITP and chronic ITP (CITP). To verify the prevalence of Helicobacter pylori (H. pylori) infection and the effects of eradicating in the patients with CITP, we investigated on a series of CITP patients with Helicobacter pylori infection and compared the effects of H. pylori eradication therapy to only prednisone treatment (or the others) in the CITP patients. We analyzed if there is significant differences in the evolution of CITP depending on the H. pylori infection status and on the response to the eradication treatment. Material and Methods 34 patients, who were diagnosed as CITP in West China Hospital of Sichuan University from October, 2003 to March, 2004, were brought into this study and were classified into two groups based on H. pylori stool antigen test (HpSA) and serological H. pylori -IgG antibody test. The patients who had positive result from the two tests of above were treatedwith H. pylori eradication and had been a long follow-up. The content of follow-up included the platelet counU HpSA, and platelet antibody. Result was expressed as mean±SD. X2 test was used for comparison of categorical data. A P value of less than 0.05 was considered significant. Results A series of 34 CITP patients had been investigated for 5 months. 20 patients (14 women, 6 men) were positive for H. pylori infection (58.82%) and received eradication treatment. There was no difference in platelet countbetween infected and uninfected patients (^±SD 40.7514><109/L[SD 32.1500]vs 23.2695xl09/L[SD 15.5151], P=0.076>0.05). Eradication of H. pylori was achieved in 11 out of 20 patients (55%). Patients in whom H. pylori waseradicated had a significant increase in platelet count (^±SD 17.0008 xlO9/L[SD 5.1259] vs 26.3841 xlO9/L[SD 7.9551], P=0.011<0.05) and decrease in platelet antibody . The platelet count did not differ before and after treatmentin those patients in whom the bacterium was not eradicated ( x ^D26.1011*109/L[SD 13.9292] vs 51.8456*109/L[SD 39.2778], P=0.138>0.05) . The first response and duration of response to maintain in the patients in whom the eradication were achieved were median 6 days (3~28days) and 75 days (17-125 days) respectively.Conclusion Our study had shown the prevalence of H. pylori infection in CITP patients was 58.82%. The bacterium eradication was obtained in 11 of 20 H. pylori-positive patients (55%). 1 (5%) of 20 patients who had been treated acquaired excellent resules, 4 patients (20%) achieved the good effectiveness and 11 patients (55%) showed the improvement, while 4 patients (20%) showed the invalid results. 9 (56.25%) of 16 valid patients(including excellent results good effectiveness and improvement) had been eradicated, while 7 (43.75%) had been failure to eradicate. 2 (50%) of 4 invalid patients achieved the eradication, and the same result in the patients were not achieved . There was significant difference in the response to the CITP patients eradication treatment. This suggested that the treatment may be a new good option for a nonimmunosuppressive treatment for the CITP patients.更多还原