儿童新诊断免疫性血小板减少症与幽门螺杆菌感染的相关性研究

Association between Helicobacter pylori infection and newly diagnosed childhood immune thrombocytopenia

目的：明确幽门螺杆菌（H.pylori）感染对儿童新诊断免疫性血小板减少症（ITP）的影响。方法选取2011年1月至2013年12月间首次住院并新诊断为ITP的495例患儿为病例组；随机选取无血小板减少及其他血液系统疾病的普通呼吸道感染住院患儿123例作为对照组。依据年龄将两组患儿分为〈1岁组（n=219）、1岁-组（n=161）、3岁~组（n=76）和7-14岁组（n=39）。回顾性分析各年龄段患儿H.pylori感染率，以及H.pylori感染阳性及阴性ITP患儿经过相同治疗后的预后情况。结果病例组中H.pylori感染率随着ITP患儿年龄的增长而增加，与对照组各年龄段H.pylori感染率比较差异均无统计学意义（均P〉0.05）。H.pylori感染阳性ITP患儿均未接受针对H.pylori的相关治疗，而针对血小板减少经丙种球蛋白和/或激素治疗后缓解率随着年龄的增长而呈现逐渐下降趋势，与各年龄段H.pylori阴性的ITP患儿治疗后缓解率比较差异均无统计学意义（均P〉0.05）。结论 H.pylori感染可能不是ITP患儿发病的一个主要致病因素；是否治疗H.pylori并不影响儿童急性ITP的治疗效果。

Objective To study the role of Helicobacter pylori （H. pylori） infection in newly diagnosed childhood immune thrombocytopenia （ITP）. Methods A total of 495 children with newly diagnosed ITP who were hospitalized for the ifrst time between January 2011 and December 2013 were included as the case group. A total of 123 children with common respiratory tract infection （not ITP or other diseases of blood system） were randomly selected as the control group. All patients were divided into four groups by age：〈1 year group, 1-3 years group, 3-7 years group, and 7-14 years group. The incidence of H. pylori infection in all age groups and the clinical outcomes of ITP children with or without H. pylori infection were retrospectively analyzed. Results The incidence rate of H. pylori infection in the case group increased with increasing age. There was no signiifcant difference in the incidence rate of H. pylori infection between the case and the control groups among subjects of the same age （P〉0.05）. All the ITP patients were not given anti-H. pylori treatment and only received the treatment （glucocorticoid and/or immunoglobulin） for ITP, and their remission rate declined with increasing age. There was no signiifcant difference in the remission rate between the ITP children with H. pylori infection and those without H. pylori infection in the same age group （P〉0.05）. Conclusions H. pylori infection may not be a major cause of ITP in children, and the clinical outcomes of children with acute ITP are not affected by receiving anti-H. pylori treatment or not.