人巨细胞病毒感染与儿童特发性血小板减少性紫癜的关系

The relationship between human cyto-megalo virus infection and idiopathic thrombocytopenic purpura in children

目的探讨人巨细胞病毒(human cyto-megalo virus,HCMV)感染与儿童特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)的关系。方法选择2013-2016年某院诊治的193例ITP患儿作为病例组,同时按照性别相同、年龄相近原则,选择98例体检正常儿童作为对照组,分别采集两组对象的尿样,采用荧光定量PCR检测HCMV-DNA,并比较HCMV阳性患儿与阴性患儿的骨髓巨核细胞计数及治疗效果。结果 ITP患儿HCMV阳性率(61. 14%)高于健康对照组(23. 47%),差异有统计学意义(χ^2=36. 929,P <0. 01)。HCMV阳性ITP患儿的骨髓巨核细胞总数均值少于阴性患儿,差异有统计学意义(t=-5. 19,P <0. 01)。HCMV阳性ITP儿童单纯使用糖皮质激素治疗总有效率仅33. 05%,同时使用更昔洛韦治疗可提高治疗总有效率至75. 42%。结论 HCMV感染可能是诱发儿童ITP的原因之一,临床上对ITP患儿应开展HCMV检测,及时发现,并及时给予更昔洛韦对症治疗。

Objective To investigate the relationship between human cyto-megalo virus infection and idiopathic thrombocytopenic purpura in children. Methods A total of 193 cases of idiopathic thrombocytopenic purpura treated in our hospital from 2013 to 2016 were selected as case group. 98 health children were selected as control group according to the same gender and similar age. Urine samples of the two groups were collected,and HCMV-DNA was detected by real-time PCR. At the same time,the bone marrow megakaryocyte counts and therapeutic effects of HCMV positive children were compared with the negative ones. Results The positive rates of HCMV in case group was 61. 14%,which was significantly higher than that in control group(23. 47%),and the difference was statistically significant(χ^2= 36. 929,P < 0. 01). Among the idiopathic thrombocytopenic purpura patients,the average number of bone marrow megakaryocytes in HCMV positive ones was less than that in negative ones,and the difference was statistically significant(t =-5. 19,P < 0. 01). The general effective rate of 118 cases with HCMV infection treated with corticosteroids alone was only 33. 05%,while the total effective rate of 118 cases with HCMV infection treated withganciclovir increased to 75. 42%. Conclusion HCMV infection may be one of the causes of ITP in children. Clinically,HCMV detection should be carried out in ITP children,and timely detection and symptomatic treatment of ganciclovir should be given.