【摘要】 目的 :探讨巨细胞病毒 (CMV)和Epstein Barr病毒 (EBV)感染与儿童特发性血小板减少性紫癜 (ITP)的关系。方法 :采用基础PCR方法检测了 44例ITP患儿外周血白细胞中CMV和EBV的感染情况 ,并结合实验室及临床特征进行分析。结果 :①ITP患儿CMV感染阳性率较高 ,达 6 1.4% ;在慢性反复发作的患儿中 ,CMV阳性率更高 (71.9% ) ,显著高于急性ITP患儿 (33.3% ) (χ2 =5 .47,P <0 .0 5 )。CMV阳性患儿血小板自身抗体阳性率较高 ,血小板及巨核细胞数均较低 ,出血症状明显 ,激素治疗效果较差。② 5 0 %的ITP患儿外周血EBVDNA阳性 ,急性患儿较多见 ,但与慢性患儿比差异无显著性意义。EBV阳性患儿血小板自身抗体阳性率也较高 ,以抗GPⅡb/Ⅲa升高最明显 ,显著高于EBV阴性患儿 (χ2 =4.96 ,P <0 .0 5 )。与CMV阳性患儿相比 ,EBV阳性患儿血小板减少多为轻、中度 ,骨髓中巨核细胞数正常或增多 ,出血症状少见 ,预后较好。结论 :CMV和EBV感染与部分儿童ITP的发病有关 ,不同的病毒感染有不同的发病机制和临床特征。更多还原

【Abstract】 Objective:To elucidate the epidemiology of cytomegalovirus (CMV) and Epstein Barr virus (EBV) in children with ITP.Method:CMV and EBV infection was detected in 44 children with ITP by PCR method, which was analyzed with the clinic and laboratory characteristics of these children.Result:Specific viral DNA indicating a current or recent viral infection was detected in 27 patients ( 61.4 %) for CMV and 22 (50%) for EBV by PCR method, respectively. Children with chronic ITP ( 71.9 %) had significantly higher CMV infection compared with acute ITP ( 33.3 %) (χ 2= 5.47 ,P< 0.05 ), though there was no significant difference in EBV infection between acute and chronic ITP groups. The clinical manifestations and laboratory data were analyzed in patients with and without virus infection. Children with ITP and associated CMV infection are characterized by a higher positivity of antiplatelet antibodies as well as a lower platelet and megakaryocyte count than patients without CMV infection. Moreover, affected children often showed severe hemorrhaging and poor response to steroids. Thus, infection with CMV should be considered in cases of severe, treatment resistant ITP. However, EBV associated ITP usually manifest as benigh acute onset, mild to moderate thrombocytopenia, normal or increased number of megakaryocyte in the bone marrow and fewer bleeding complications. Anti GPIIb/IIa antibody showed a remarkable increase in EBV positive patients (χ 2= 4.96 ,P< 0.05 ) compared to non EBV patients.Conclusion:CMV and EBV should be considered as possible etiologic agents in some children with ITP. Probing into the pathogenesis and clinical features of different virus associated ITP could provide theoretical basis for treatment and prognostic information.更多还原