特发性血小板减少性紫癜巨核系祖细胞巨细胞病毒感染的临床研究  

A clinical study on human cytomegalovirus infection in colony forming unit-megakaryocyte in patients with idiopathic thrombocytopenic purpura

作　　者：肖燕[1] 林雯[1] 刘勤[1] 金润铭[1] 费洪宝[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院儿科,武汉430022

出　　处：《中华儿科杂志》2006年第5期346-349,共4页Chinese Journal of Pediatrics

摘　　要：目的特发性血小板减少性紫癜(ITP)是儿童常见的出血性疾病,其病因尚不十分清楚。很多研究表明,该病的发生与病毒感染密切相关。探讨人类巨细胞病毒(HCMV)感染巨核系祖细胞致ITP血小板减少的发病机制及其有效的治疗方法。方法HCMV相关ITP骨髓巨核细胞集落形成单位(CFU-MK)体外培养技术收集集落细胞,采用逆转录-聚合酶链反应(RT-PCR)检测HCMV晚期抗原基因mRNA,并给予更昔洛韦治疗。结果46例血清HCMV-DNA PCR阳性或血清HCMV-IgM阳性的ITP骨髓巨核细胞集落形成单位(CFU-MK)集落细胞HCMV晚期抗原基因mRNA阳性19例,更昔洛韦治疗有效16例;mRNA阴性27例,更昔洛韦治疗有效4例。阳性组疗效高于阴性组,P<0.01,差异有统计学意义。结论HCMV可感染CFU-MK而成为ITP血小板减少的原因之一。巨核系祖细胞HCMV晚期抗原基因mRNA检测阳性者更昔洛韦治疗有效,能使血小板上升或恢复正常。Objective Idiopathic thrombocytopenic purpura （ITP） is a hemorrhagic disease in children with blood platelets redundant destruction caused by chaotic immunological mechanism. However, some patients with ITP with negative platelet-asseciated antibody and ineffective adrenal cortical hormone therapy probably have special pathogenesis. It is indicated that the human cytomegalovirus （HCMV） can incubate in haemopoietic stem cell / ancestral cell to inhibit its generation and differentiation. Therefore, the study was designed to investigate HCMV-late mRNA expression in megakaryoblast for the purpose of examining the pathogenesis of ITP and to examine the effectiveness of ganciclovir on ITP. Methods Colony forming unit-megakaryocyte （CFU-MK） of 46 ITP patients with HCMV infection were incubated. Reverse transcription-polymerase chain reaction （RT-PCR） was subsequently used for HCMV-late mRNA detection. Ganciclovir therapy was given to both positive group and negative group for comparison of therapeutic effectiveness. Results Nineteen out of 46 CFU-MK culture cell specimens with positive HCMV-DNA by PCR or positive CMV-IgM by enzyme linked immunosorbent assay （ELISA） from serum of peripheral blood showed positive for HCMV-Iate mRNA. While, the remaining 27 were negative. Sixteen positive responders to ganciclovir therapy were observed amongst those with positive HCMV-DNA. Whereas, only 4 positive responders to ganciclovir therapy were noticed amongst those with negative HCMV-DNA. The curative effectiveness in positive group was significantly higher than that in negative group （ P 〈0.01 ）. Conclusion HCMV can directly infect CFU-MK, which might be one of the mechanisms responsible for ITP. Ganciclovir is an effective therapy resulting in an increase in thrombocyte in rTP patients whose HCMV- late mRNA was positive in their CFU-MK.

关 键 词：巨细胞病毒感染 紫癜 血小板减少性 特发性 巨核细胞 更昔洛韦 

分 类 号：R725.5[医药卫生—儿科]