成人慢性免疫性血小板减少症与幽门螺杆菌CagA蛋白的临床相关性研究  

The correlative between adult's chronic immune thrombocytopenia and helicobacter pylori CagA protein

作　　者：吴良华[1,2] 李慧[1] 万纯黔[1] 祝彪[1] 王晓冬[1] 王春森[1] 张晋琳[1] 

机构地区：[1]四川省医学科学院.四川省人民医院血液科,四川成都610072 [2]福建医科大学附属闽东医院血液科,福建福安355000

出　　处：《实用医院临床杂志》2013年第3期56-61,共6页Practical Journal of Clinical Medicine

基　　金：四川省卫生厅科研基金资助项目(编号:303.005.002.280.040)

摘　　要：目的探讨幽门螺旋杆菌(Helicobacter pylori,H.pylori)CagA蛋白(H.pylori-CagA)在慢性免疫性血小板减少症(Chronic Immune thrombocytopenia,CITP)患者发病中的作用。方法收集四川省人民医院110例伴有H.pylori感染的CITP患者,按就诊先后顺序编号后,应用随机数字表分为治疗组与对照组各55例,进行CagA蛋白抗体定性、定量检测。治疗组接受根除H.pylori治疗,对照组不接受根除H.pylori治疗,其他治疗方案两组相同。6～8周后复查14碳尿素酶呼气试验(14C-urea breath test,14C-UBT),3～5个月随访监测患者治疗前后血小板计数、H.pylori-CagA-IgG浓度变化,比较两组间是否存在显著差异,进而探讨CITP与幽门螺杆菌CagA蛋白的临床相关性。结果 110例患者中46例CagA蛋白抗体阳性,CagA阳性率41.82%(46/110);治疗组23例H.pylori-CagA阳性病例根除H.pylori治疗后血小板计数明显改善,H.pylori-CagA蛋白抗体滴度较前降低,且有效率明显高于对照组,差异均有统计学意义(P<0.05);而32例CagA蛋白抗体阴性病例治疗前后血小板数量变化无统计学意义(P>0.05)。对照组23例H.pylori-CagA阳性病例H.pylori-CagA蛋白抗体滴度及血小板数量变化无统计学意义(P>0.05);32例CagA蛋白抗体阴性病例,治疗前后血小板数量变化无统计学意义(P>0.05)。提示H.pylori-CagA蛋白与CITP的发生、发展密切相关。结论对有H.pylori感染的CITP患者增加血清抗体检测,对于临床上治疗CITP可能有良好的预测作用且H.pylori-CagA抗体阳性者进行根除H.pylori治疗可作为一个新的非免疫治疗的方法,不良反应少。The purpose of this study was to investigate the role of Helicobacter pylori CagA(H.pylori-CagA) protein in adult patients with chronic immune thrombocytopenia(CITP). One hundred and ten CITP patients with H.pylori infection in the Sichuan Provincial People's Hospital were involved.They were?divided into treatment group and control group using random number table according to numbers that was first-come first ordered.Each group contained 55 cases.Serum antibodies against CagA protein were qualitatively and quantitatively measured.The treatment group received H.pylori eradication therapy,while the control group did not.However,other treatment options were the same between the two groups.Eradication was assessed after 6～8 weeks of treatment by 14C-UBT.The change of platelet count and serum levels of H.pylori-CagA-IgG antibody titer in the CITP patients were evaluated before and after treatment during follow-up period of 3 to 5 months in order to find whether or not there were significant differences between the two groups and to explore the clinical relationship between CITP and H.pylori-CagA protein. There were 46 patients with H.pylori-CagA positive.The prevalence of H.pylori CagA infection was 41.82%(46/110).After H.pylori eradication treatment,the platelet count was increased and the serological levels of H.pylori-CagA-IgG were reduced in 23 patients with H.pylori-CagA positive in the treatment group(P<0.05).There was no significant difference in the number of platelets in 32 cases with H.pylori-CagA negative before and after treatment.In the control group,no statistical difference in serological levels of H.pylori-CagA-IgG and platelet count change was found in 23 patients with H.pylori-CagA positive.There was also no significant difference in the number of platelets in the 32 cases with H.pylori-CagA negative before and after treatment.These results suggested a close correlation between H.pylori-CagA protein and CITP development. The addition of serum antibody test may be used as a predictor for clinical tr

关 键 词：慢性免疫性血小板减少症 幽门螺杆菌 幽门螺杆菌CagA蛋白 

分 类 号：R593[医药卫生—内科学] Q51[医药卫生—临床医学]