幽门螺杆菌感染在特发性血小板减少性紫癜中的临床意义  

Clinical meaning of Helicobacter pylori in idiopathic thrombocytopenic purpura

作　　者：饶燕飞[1] 严志民[2] 杨桂玲[2] 汪清铭[2] 杨碧云[2] 王小中[1] 

机构地区：[1]南昌大学第二附属医院检验科,330006 [2]南昌大学第二附属医院血液科,330006

出　　处：《重庆医学》2012年第2期113-116,共4页Chongqing medicine

摘　　要：目的探讨幽门螺杆菌(Hp)在特发性血小板减少性紫瘢(ITP)患者的感染情况、Hp感染与ITP患者临床特点的相关性及针对Hp感染的ITP患者采用糖皮质激素联合根治性Hp治疗的临床疗效。方法对ITP患者57例及正常对照30例采用14 C-尿素呼气试验(14 C-UBT)和抗Hp抗体IgG(Hp-IgG)检测确定是否合并Hp感染,阳性组和阴性组分别采用糖皮质激素联合根治性Hp治疗和单用糖皮质激素治疗,观察血小板数、T细胞亚群变化,并进行疗效比较。结果 ITP患者Hp感染率高于对照组,差异有统计学意义(P<0.05)。阳性组和阴性组平均年龄、骨髓巨核细胞数、临床表现比较差异有统计学意义(P<0.05)。治疗前T细胞亚群比例均有不同程度的失调,且阳性组CD3+CD4+百分比及CD3+CD4+/CD3+CD8+比值降低、CD3+CD8+百分比升高分别较阴性组明显。Hp根除治疗成功率为82.50%(33/40)。根除Hp成功组平均血小板计数上升及升高幅度、T细胞亚群失调改善及改善幅度均高于根除Hp失败组和阴性组(P<0.05)。阳性组有效率高于阴性组(P<0.05)。治疗后14 C-UBT检测与临床疗效相符,而Hp-IgG检测与临床疗效不完全相符。结论 ITP患者Hp感染率高于正常人群。Hp阳性组患者平均年龄及骨髓巨核细胞代偿性增生程度高于阴性组,ITP患者T细胞亚群比例均有不同程度失调。糖皮质激素联合根治性Hp治疗有助于阳性组患者血小板数的提升及T细胞亚群比例失常的改善。14 C-UBT和Hp-IgG是两种简便的非侵入性Hp的检测方法,需根据不同特点用于临床。Objective To approach that Helicobacter pylori（Hp） infection rate in patients with idiopathic thrombocytopenic pupura（ITP）,Hp infection dependablity on clinic features of ITP patients,the clinic effect of glucocorticosteroid associating with Hp radical cure to ITP patients infected by Hp.Methods To definite if 57 ITP patients and 30 normal controls were infected Hp was adopted the two means of 14C-UBT and Hp-IgG.To compare platelet counts and T-cell subpopulations before treat and after treat between the ITP patients diagnosed with Hp（the positive group） and the ones without Hp（the negative group）,which the formers were treated with glucocorticosteroid associating with Hp radical cure and the others only with glucocorticosteroid.Results The infection rate of 57 ITP patients was 70.18%（40/57）,and the infection rate of the normal control group was 46.67%（14/30）,The discrepancy was significant（P0.05）.The mean age in the positive group and the negative group was respectively（48.35±17.95） years old and（35.65±16.94） years old（P0.05）.The mean myelo-megacaryocyte count of the two groups was respectively 142.00±54.59 and 110.29±43.39（P0.05）.The positive group was more outstanding than the negative group on clinical situations.Of all the 57 ITPs on admission,the percentage of CD3＋CD4＋[（19.69±5.33）%] and the ratio of CD3＋CD4＋/CD3＋CD8＋（0.28±0.10） were degreeded,The percentage of CD3＋CD8＋ [（72.17±5.14）%] was heighened.The percentage of CD3＋CD4＋[（16.96±3.10）%] and the ratio of CD3＋CD4＋/CD3＋CD8＋（0.22±0.04） in the positive group was lower than those in the negative group respectively.And the percentage of CD3＋CD8＋[（74.82±3.02）%] in the positive group was higher than that in the negative group.The achievement ratio of Hp radical cure was 82.50%（33/40）.The change of platelet count and T-cell subpopulation were improved in patients with idiopathic thrombocytopenic pupura（ITP）,and the change of the successfully eradi

关 键 词：紫癜 血小板减少 特发性 幽门螺杆菌 

分 类 号：R554.6[医药卫生—血液循环系统疾病]