抗幽门螺杆菌的治疗在免疫性血小板减少症中的初步临床观察

The preliminary clinical observation of anti-Helicobacter pylori treatment in Immune thrombocytopenia disease

目的比较糖皮质激素联合幽门螺杆菌(HP)根治术与单用糖皮质激素治疗免疫性血小板减少症(ITP)患者的临床疗效,探讨HP感染在ITP发病中的作用。方法 60例符合ITP诊断标准患者为ITP组,对照组为30例健康体检者,比较两组幽门螺杆菌感染情况。将ITP组患者随机分为联合用药组30例(糖皮质激素+HP根治术);单独用药组30例(单用糖皮质激素)。用药4周后观察血小板恢复情况,复发情况进行临床疗效评估。结果①ITP组Hp感染率为73.3%,而对照组56.7%,两者差异具有统计学意义(P<0.05)。②联合用药组行HP根治术后,血小板均数为(76.25±26.17)×109L-1,与治疗前比较,差异显著(P<0.05);单独用药组血小板均数(50.65±13.39)×109L-1,较治疗前提高(P<0.05)。③联合用药组总有效率为86.7%,单独用药组有效率为50%,差异显著(P<0.05)。结论在糖皮质激素治疗的基础上联合HP根治术能显著改善伴HP感染的ITP患者的血小板计数,延缓复发率,对ITP的治疗效果显著,HP根治术可能成为治疗ITP的另一非免疫抑制疗法。

Objective Compare the clinical curative efficacy between the group of glucocorticoid combined with Hp eradication and the glucocorticoid group in Immune thrombocytopenia （ITP）patients to investigate the significance of Hp infection in pathogenesis of Immune thrombocytopenia. Methods 60 patients with ITP diagnostic criteria as ITP gruop , 30 healthy individuals as control , compare the helicobacter pylori infection of two groups. ITP group was randomly divided into the combined treatment group 30 cases（ glueocorticoid ＋ Hp eradication） ; the glucocorticoid group（ glucocorticoid ）30 cases. 8. weeks later,observe the platelet level, relapse rate to assess clinical effect. Results （1）The results showed that HP infection rate in ITP group was 73.3% , while the control group was 56.7% , there was significant difference between two groups （ P 〈 0.05 ）. （2）combined treatment group, the mean platelet count was （76.25 ± 26.17） × 10^9/L after Hp eradication, there was significant difference compared with treatment before （ P 〈 0.05 ） ; the glucocorticoid group, the mean platelet count was （50.65 ± 13.39）× 10^9/L,the count was improved compared with treatment before（P 〈0.05）. （3）the total effective rate of combined treatment group was 86.7% ,while glucocorticoid group was 50% , there was significant difference between the two group （P 〈 0.05）. Conclusion glucoeorticoid therapy combined with Hp eradication can significantly improve the platelet count of ITP patients with positive Hp, delay the recurrence rate. It indicate Hp eradication may become another non immunosuppressive therapy of the ITP treatment.