【摘要】 目的探讨骨髓中人巨细胞病毒(HCMV)感染在小儿特发性血小板减少性紫癜(ITP)中的作用及机制。方法采用二步法免疫组化检测81例ITP患儿骨髓中HCMV早期抗原,并行外周血血小板计数及ELISA法检测血HCMV-IgM。结果ITP患儿骨髓HCMV阳性率(61.73%)明显高于血HCMV-IgM阳性率(20.99%),P<0.01;慢性ITP骨髓HCMV阳性率(92.31%)高于急性ITP(55.88%),P<0.05;慢性ITP血HCMV-IgM、IgG阳性率与急性ITP相比,差异无统计学意义(P>0.05)。骨髓HCMV阳性组的平均年龄、治疗前血小板数、治疗后血小板上升值与阴性组相比,差异具有统计学意义(P<0.05),骨髓巨核细胞数及产板型巨核细胞数与阴性组相比,差异无统计学意义(P>0.05);血HCMV-IgM阳性组的平均年龄、治疗前血小板数、治疗后血小板上升值与阴性组相比,差异无统计学意义(P>0.05);血HCMV-IgG阳性组的上述三项指标与阴性组相比,差异亦无统计学意义(P>0.05)。骨髓HCMV阳性细胞数量分级与治疗前血小板计数之间无相关关系(P>0.05)。结论HCMV感染在ITP中广泛存在,骨髓HCMV抗原的检测是评价ITP患儿HCMV感染的敏感、特异的指标;骨髓HCMV感染的ITP患儿存在病情加重、疗效不佳及慢性化的趋势;在骨髓HCMV致ITP的机制中,可能主要是影响外周免疫系统从而破坏成熟的血小板,而不是对血细胞生成的抑制。更多还原

【Abstract】 Objectives To explore the effect of myeloid human cytomegalovirus(HCMV)infection in children with idiopathic thrombocytopenic purpura(ITP).Methods Eighty-one subjects with ITP were recruited.Two-step immunohistochemistry assay was used to detect HCMV-early antigen(EA)in bone marrow.The platelets in blood were counted and HCMV IgM and IgG in serum was detected by ELISA.Results The detection rate of HCMV from bone marrow was significantly higher than that from blood(P < 0.01).The detection rate of myeloid HCMV antigen in chronic ITP was significantly higher than that in acute ITP(P < 0.05).There were no significant differences between the positive rates of HCMV-IgM and IgG between chonic and acute ITP groups(P > 0.05).The average age of onset,pre-treatment platelet count,and the increment of platelet counts after treatment were significantly different between myeloid HCMV-positive and negative groups(P < 0.05=.There was no significant difference in the number of megakaryocyte and proplatelet megakaryocyte between these two groups(P > 0.05).There was no significant difference of average age of onset,pre-treatment platelet count,and the increase amount of platelet after the treatment between HCMV-IgM positive and negative groups,as well as between HCMV-IgG positive and negative groups(P > 0.05).There was no correlation between the grades of positive myeloid HCMV-cells and platelet count before treatment(P > 0.05).Conclusions ①HCMV is widely detected in ITP.The detection of myeloid HCMV is a sensitive and specific index for the evaluation of bone marrow HCMV infection in children ITP.②ITP Children with myeloid HCMV infection have a tendency towards exacerbation,refractoriness and chronization.③In the pathogenesis of ITP,HCMV in bone marrow might not affect hematopoiesis,but it may affect the peripheral immune system and lead to the destruction of mature thrombocytes.更多还原