抗幽门螺杆菌治疗在儿童特发性血小板减少性紫癜中的作用

The effect of Helicobacter pylori eradiation in children with ITP

目的探讨联合抗幽门螺杆菌(H.pylori)在特发性血小板减少性紫癜(ITP)患儿治疗中的作用。方法将58例血清H.pylori抗体阳性的ITP患儿随机分为:A组:给予根治性抗H.pylori,大剂量丙种球蛋白和强的松治疗;B组:未予抗H.pylori,其他治疗相同。另设正常对照组(C组):选血清H.pylori抗体阴性的健康入学儿童。观察A、B两组治疗前和3月后T细胞亚群分布,血小板相关免疫球蛋白G(PAIgG)水平变化,及两组临床疗效和复发率。结果各组间总T细胞无变化,A、B两组治疗前T细胞亚群分布异常,CD4+细胞减少,CD8+细胞增加,CD4+/CD8+比值下降,PAIgG水平升高,两组间差异无显著性(P均>0.05)。治疗后3月复查,A组CD4+细胞增加,CD8+细胞减少,CD4+/CD8+比值和PAIgG值恢复至正常对照组水平,而B组虽有所恢复,但未达正常,A组显效+良效97%,复发率为3%,B组显效+良效70%,复发率为30%,两组差异有显著性(P均<0.05)。结论对有H.pylori感染的ITP患儿,联合抗H.pylori治疗比单纯应用免疫抑制治疗,异常的T细胞亚群和PAIgG水平恢复较快,疗效较好,复发率低。

Objective To evaluate the effect of idiopathic thrombocytopenic purpura （ITP） . Methods Helicobacter pylor （ H. pylori） eradication in children with 58 cases with ITP infected H. pylori were studied. The patients were divided into two groups, and the patients were treated by eradicated H. pylori, by large dose immunoglobulin and prednisone in A group; with same treatment in B group as A group except eradicated H. pylori, the other healthy children with H. pylori negative were studied for control group （C group）. Before treatment and three months later, T cell subsets, platelet associated immunoglobulin G （PAIgG）, curative effect and recurrence were observed in A and B group. Results Total T cells were normal among all studed objects , the patients in A and B group before treatment , T cell subsets were abnormal, CD4^ ＋ cell decreased, CD8^ ＋ increased ,CD4^ ＋/CD8^ ＋ ratio decreased, PAIgG increased, while there were no difference between the two groups （P〉0.05）. Three months after treatment , CD4^ ＋ cell were increased , CD8^ ＋ cell decreased, CD4^ ＋/CD8^ ＋ ratio and PAIgG were normal in A group ;T cell subsets were reeoveed partly while not reached normal extent in B group. Obvious effective rate and good effective rate, recurrence were 97% and 3% individually in A group, 70% and 30% in B group, there were significant difference between two groups（P〈0.05） . Conclusion The children with ITP infected H. pylori after eradicated H. pylori, the recovery of abnormal T cell subsets and advanced PAIgG was faster, curative effect were better, recurrence were lower.