特发性血小板减少性紫癜与幽门螺杆菌感染的相关性研究

Relation of idiopathic thrombocytopenic purpura with Helicobacter pylori

目的研究特发性血小板减少性紫癜（ITP）与幽门螺杆菌（Hp）感染的相关性，观察抗Hp治疗对难治性ITP的疗效。方法对中国医科大学附属第一医院血液科2002年11月至2005年5月收治的48例ITP患者进行研究，正常对照组52例，因消化系统症状行胃镜和其他相关检查但未见明显异常的门诊患者。采用^13C-尿素呼气试验及Hp血清抗体联合诊断Hp感染。对11例Hp感染阳性的难治性ITP患者抗Hp治疗，采用经典的三联药物，具体为奥美拉唑20mg口服，每日2次；克拉霉素500mg口服，每日2次；阿莫西林1g口服，每日2次，连用7d，4～8周后复查^13C-尿素呼气试验、Hp血清抗体、血小板计数和血小板抗体。结果ITP组和正常对照组的Hp感染阳性率分别为68.18％（33／48），46.12％（24／52），ITP组Hp阳性率显著升高（P〈0.05）；11例常规治疗无效或复发患者并伴有Hp感染，有8例经上述治疗Hp感染转为阴性，该8例4～8周后血小板计数显著升高，其中6例血小板自身抗体消失，而Hp检测阴性患者和Hp感染未得以根治的患者随访时血小板抗体和血小板计数均无变化。结论ITP患者Hp感染阳性率高于正常人；对于Hp感染阳性的难治性ITP患者，根除Hp的方法治疗ITP是行之有效的。

Objective Clinical research was made to observe the relationship between idiopathic thrombocytopenic purpura （ITP）and Helicobacter pylori （Hp）and to evaluate the effect of Hp eradication in the treatment of refractory ITP. Methods ^13C urea breath test and Hp antibody of serum were made in 48 previously untreated patients with ITP from Department of Hematology of the First Affiliated Hospital of China Medical University during November 2004 to May 2005 years and normal controls consisted of 52 heathy peoples whose gastroscopy was normal. Omeprazole, clarithromycin and amoxicillin were used for Hp eradication to refractory ITP with Hp infection. ^13C urea breath test, Hp antibody of serum and the level platelet and PAIgG was detected after therapy 4 ～ 8 weeks. Results Of 48 cases with ITP, 33 （68.18% ） had Hp infection and 24 of 52 （46.12% ）normal population had Hp infection, the infection rate of Hp in ITP patients being statistically higher than the control group（ P〈0.05 ） ;11 cases of refractory ITP with Hp infection were treated by Hp eradication. Eight of 11 cases got rid of it. The level of PAIgG of 6 cases was not detected. The average level of platelet was higher than that before therapy（P 〈 0.05 ）. Conclusion The prevalence of Hp infection is higher in ITP patients than in general population;Hp eradication is effective in the treatment of refractory ITP.