核因子-κB、幽门螺杆菌细胞毒素相关蛋白A在特发性血小板减少性紫癜发病中的作用

The role of nuclear factor kappa B and helicobacter pylori associated protein A in the pathogenesis of idiopathic thrombocytopenic purpura

目的 对特发性血小板减少性紫癜（ITP）患者的核因子-κB（NF-κB）、幽门螺杆菌（Hp）、幽门螺杆菌细胞毒素相关蛋白A（CagA）、血小板（PLT）、血小板相关IgG抗体（PA-IgG）进行检测分析,探讨NF-κB、cagA在ITP发病机制中的作用,寻找改善ITP预后的方法.方法 SABC法检测NF-κB,C^13尿素呼气试验（uBT）检测Hp,酶联免疫法测定外周血cagA、PA-IgG,全自动血细胞分析仪测定PLT.依据检测结果将患者分为Hp＋cagA＋NF-κB＋、Hp＋cagA＋NF-κB-、Hp＋cagA-NF-κB＋、Hp＋cagA-NF-κB-、Hp-NF-κB＋、Hp-NF-κB-六组.对各组PA-IgG、PLT进行统计学分析.结果 224例ITP,Hp阳性175例,阳性率78.13%.175例Hp＋,其中cagA＋91例,Hp＋中占52%,总体中占43.63%.NF-κB＋共108例,总阳性率46.21%;其中Hp＋cagA＋中78例,阳性率85.71%;Hp＋cagA-中21例,阳性率25%;49例Hp-中9例NF-κB＋,占18.37%.分析各组PLT、PA-IgG,Hp＋较Hp-组,Hp＋cagA＋较Hp＋cagA-组,NF-κB＋较NF-κB-组,PLT低、PA-IgG高,差异有统计学意义（P〈0.05）.结论 cagA可能直接或通过激活NF-κB参与免疫应答,致ITP患者PA-IgG升高,血小板降低.

Objective To detect and analyze nuclear factor kappa B （NF-κB）,Helicobacter pylori （HP）,Helicobacter pylori cytotoxin associated protein A （CagA）,platelet （PLT） and platelet associated IgG （PA IgG） in 224 patients with idiopathic thrombocytopenic purpur（ITP） from three urban hospitals of Shaoxing,in order to explore the role of NF-κB and CagA in the pathogenesis of ITP,then to improve the prognosis of ITP.Methods SABC method was used to detect the NF-κB,13C breath test for the determination of the Hp infection.CagA and PA-IgG were tested by enzyme linked immunosorbent assay.Automatic blood cell analyzer was used to measure PLT.According to the test results,the patients were divided into Hp＋cagA＋NF-κB＋,Hp＋cagA＋NF-κB-,Hp＋cagA-NF-κB＋,Hp＋cagA-NF-κB-,Hp-NF-κB＋,Hp-NF-κB-PLT groups,and PA-IgG,PLT of the six groups were statistically analyzed.Results Of 224 cases with ITP,175 cases of HP positive,the positive rate was 78.13%.CagA＋ 91 cases in 175 cases of Hp＋,accounting for 52%,overall 43.63%.NF-kappa B＋ 108 cases,the positive rate was 46.21%,78 cases were found in Hp＋cagA＋,accounting for 85.71% in cagA＋.In 84 cases of Hp＋cagA-,there were 21 cases NF-κB＋,the positive rate was 25%.In 49 of HP-,9 cases with NF-kappa B＋,accounting for 18.37%.PLT and PA-IgG were compared among the groups.The count of PLT of group Hp＋,group Hp＋cagA＋ and group NF-κB＋ was lower than group Hp-,group Hp＋cagA- and group NF-κB-.However,the level of PA-IgG of group Hp＋,group Hp＋cagA＋ and group NF-κB＋ was higher than group Hp-,group Hp＋cagA- and group NF-κB-,the difference was statistically significant（P〈0.05）.Conclusion CagA maybe directly or through the activation of NF-kappa B take part in the immune response of ITP,cause PA-IgG increased and thrombocytopenia.