幽门螺杆菌感染与慢性特发性血小板减少性紫癜的临床观察

Clinical Observation on Relationship Between Helicobacter Pylori Infection with Chronic Idiopathic Thrombocytopenic Purpura

目的考察幽门螺杆菌（Hp）在慢性特发性血小板减少性紫癜（CITP）患者中的感染情况，探讨针对Hp感染的CITP患者采用根除Hp治疗，是否有助于血小板的上升。方法通过检测CITP患者粪便Hp抗原（HpSA）和外周血HPIgG抗体，以确定是否有Hp感染。对确诊的有Hp感染的CITP患者在其原治疗方案基础上加用根除Hp治疗（奥美拉唑20mg＋克拉霉素0．5g＋阿莫西林1．0g，1日2次×1周），比较治疗前后血小板数量。结果34例CITP患者中有Hp感染20例，感染率58．82％。20例患者中，成功根除Hp11例，根除率55％。成功根除Hp的11例患者治疗前后的血小板统计学比较有差异（17．00±5．13×10^9／L，vs26．38±7．96×10^9／L，P=0．011）；未成功根除Hp的9例患者治疗前后血小板数量在统计学比较上无差异（26．10±13．93×10^9／L vs 51．85±39．28×10^9／L，P=0．138）。给予根除Hp治疗的20例患者中，治疗有效病例16例（80％），无效4例（20％）。根除Hp治疗有效患者中血小板开始上升的时间为3—28d，中位时间为6d；维持有效的时间为17—125d，中位时间为75d。结论本临床观察中，CITP患者合并Hp感染率为58．82％，采用根除Hp治疗的根除率为55％，根除Hp治疗有助于Hp感染的CITP患者血小板恢复。

Objective To verify the status of helicobacter pylori （Hp） infection in the patients with chionic iniopathic the thromboctopenic purpura（ CITP）, and explore the effects on the platelets count of CITP patients after eradicating therapy for Hp. Methods 34 patients, who were diagnosed as CITP, were brought into this study and classified into two groups based on Hp antigen test （HpSA）from stool samples and serological Hp IgG antibody test. The patients who had positive results from both tests of above were treated with Hp eradication regimen （ omeprazole 20 mg with clarithromycin 0. 5 g with amoxicillin 1.0 g, twice perday for one week） ,and had been in follow up. Results 20 of 34 CITP patients were positive for Hp infection（58. 82% ） and received eradication treatment. The clearances of Hp were achieved in 11 out of 20 patients（55% ）. The patients in whom Hp were eradicated had significant platelets count increased （ 17.00 ± 5.13 × 10^9/L vs 26.38 ±7.96 × 10^9/L,P = 0. 011 ）, but it was no significant variety in those patients in whom the bacteria were not eradicated （ 26. 10 ± 13.93 × 10^9/L vs 51.85 ± 39.28 × 10^9/L, P = 0. 138 ）. As evaluation the effects for CITP, 16 of 20 patients had responses（80% ） ,while 4 patients（20% ）showed the invalid results. The time at patients＇ platelets count elevated initially were 3 - 28 days （mean 6 days）after eradicating therapy, and maintained an effective count for 17 - 125 days（ mean 75 days）. Conclusion Our study had shown the prevalencde of Hp infection in CITP patients was 58.82%, the bacterium eradication were obtained in 11 of 20 Hp positive patients（55% ）, and it is significant useful to increase the platelets count of CITP patients combined with Hp eradication treatment.