更昔洛韦治疗特发性血小板减少性紫癜应用指征

Applied Indication of Ganciclovir in Human Cytomegalovirus-Related Idiopathic Thrombocytopenia Purpura

目的探讨更昔洛韦(GCV)治疗人巨细胞病毒(HCMV)感染相关的特发性血小板减少性紫癜的(ITP)应用指征。方法选择血清HCMV DNA PCR和(或)HCMV IgM检测呈阳性ITP患儿46例,采用逆转聚合酶扩增反应(RT-PCR)检测巨核系祖细胞中HCMV晚期抗原mRNA,并行GCV治疗,判定其疗效及应用指征。结果46例血清HCMV-DNA PCR阳性和(或)血清HCMV-IgM阳性的ITP骨髓巨核祖细胞HCMV晚期抗原基因mRNA阳性19例,GCV治疗有效16例,mRNA阴性27例,GCV治疗有效4例。阳性组疗效高于阴性组,有显著性差异(P<0.01)。结论HCMV感染的ITP患儿,若对常规治疗无效,应检测其巨核祖细胞内HCMV晚期抗原基因mRNA,阳性者是应用更昔洛韦的有效指征。

Objective To explore the applied indication of ganciclovir in human cytomegalovirus（HCMV） - related idiopathic throm- bocytopenia purpura（ITP）. Methods We used reverse transeriptase - polymerase chain reaction （RT- PCR） for HCMV late antigen rnRNA in bone marrow with HCMV - related ITP on megakaryoblast and followed by ganciclovir therapy. Results Of 46 megakaryoblast culture cells specimens examined with HCMV-DNA by PCR or CMV-lgM by enzyme linked immunosorbent assay （ELISA） from serum of peripheral blood, 19 were positive for HCMV - late rnRNA by RT- PCR on megakaryoblast in bone marrow; 16 of them had effect by Ganciclovir therapy;and 27 were negative for HCMV- late rnRNA;4 of them had an effect upon ganciclovir therapy. Curative effective cases in positive group were higher than those in negative group（P〈0.01 ）. There were significant difference between two groups. Conclusions HCMV - late mRNA on megakaryoblast in children with HCMV - related ITP who were refractory in conventional therapy shall be detected. The positive patients can adopt ganciclovir therapy.