成人慢性特发性中性粒细胞减少症与幽门螺杆菌感染的临床相关性研究  

Clinical Association of Adult Chronic Idiopathic Neutropenia with Helicobacter pylori Infection

作　　者：封蔚莹[1] 罗婷[1] 钟永根[1] 罗洪强[1] 傅佳萍[1] 

机构地区：[1]浙江省绍兴市人民医院血液科,绍兴市医学研究中心,绍兴312000

出　　处：《华中科技大学学报（医学版）》2013年第4期476-479,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：浙江省绍兴市科技局一般项目(No.2009A33030)

摘　　要：目的研究成人慢性特发性中性粒细胞减少症(ACIN)患者与幽门螺杆菌(Hp)感染的关系,并探讨ACIN患者的Hp感染与脾肿大、血清炎症因子、超敏C反应蛋白(hsCRP)的关系。方法选取88例ACIN患者(ACIN组),40名健康体检者(对照组),采用14 C呼气试验检测Hp感染,B超检测并计算矫正脾指数(CSI),双抗体夹心ELISA法测定血清IL-6、IL-8、IL-10,颗粒增强免疫沉淀法测定血清hsCRP。ACIN组Hp阴性患者单以利可君治疗,Hp阳性患者联用利可君和三联抗Hp治疗(奥美拉唑+克拉霉素+阿莫西林)。结果①ACIN组Hp感染率60.23%,明显高于对照组35.00%(P<0.05)。②ACIN组Hp阳性患者抗Hp联合治疗后,抗粒细胞减少治疗总有效率77.36%,1年随访复发率20.69%,与Hp阴性患者51.43%、75.00%比较差异有统计学意义(均P<0.05)。③ACIN组及对照组Hp阳性患者CSI值明显高于同组内阴性患者;随访满1年的38例Hp阳性ACIN组未复发患者CSI值较其治疗前明显下降(P<0.05)。④ACIN组及对照组Hp阳性患者血清IL-6、IL-8、IL-10、hsCRP水平均明显高于同组内阴性患者(均P<0.05);ACIN组Hp阳性患者IL-6明显高于对照组Hp阳性患者,IL-10则明显下降(均P<0.05);ACIN组Hp阴性患者IL-6、IL-8、IL-10、hsCRP与对照组Hp阴性患者差异无统计学意义。随访满1年的38例Hp阳性ACIN组未复发患者IL-6、IL-10恢复至Hp阴性对照组水平。⑤ACIN组中性粒细胞计数与IL-6水平呈显著负相关,与IL-10水平呈显著正相关。结论 Hp感染可能是部分ACIN的病因,抗Hp联合治疗疗效好。Hp感染可能通过脾肿大及血清IL-6、IL-10变化诱发ACIN。Objective To study the correlation of Helicobacter pylori（Hp） infection with splenomegaly,the levels of serum inflammatory factors and high-sensitivity c-reactive protein（hsCRP） in patients with adult chronic idiopathic neufropenia（ACIN） patients in an attempt to explore the clinical association of ACIN with Hp infection.Methods A total of 88ACIN patients（ACIN group） and 40normal subjects（control group） were enrolled.14 C breath test was used to determine the Hp infection.Corrected splenic index（CSI） was calculated by using B-mode ultrasonography,the levels of serum interleukins（IL-6,IL8,and IL-10） by double-antibody sandwich ELISA and the serum hsCRP level by immunolurbidimelric assay.In the ACIN group,Hp-negative patients were treated with leucoson and Hp-positive patients with leucoson and three-drug combination treatment（omeprazole＋clarithromycin＋amoxycillin）.Results ①Hp incidence in ACIN group was 60.23%,significantly higher than in control group（P〈0.05）.②The total effective rate for neutropenia was 77.36%,and 1-year recurrence rate was 20.69%in Hp-positive patients,which were significantly different from those in Hp-negative patients（total effective rate ： 51.43%,1-year recurrence rate ： 75.00%）（P〈0.05）.③The CSI was significantly higher in Hp-positive subjects than in the Hp-negative subjects in both ACIN and control groups.Among the 38Hp-positive patients in ACIN group through one-year follow-up,the CSI in patients without recurrence was significantly decreased compared with those before treatment（P〈0.05）.④The levels of serum IL-6,IL-8,IL-10,and hsCRP were much higher in Hp-positive subjects than in Hp-negative ones in both ACIN and control groups（P〈0.05）.The level of serum IL-6was substantially enhanced and the serum IL-10 level decreased in Hp-positive patients in ACIN group when compared with those in control group（P〈0.05）.There were no significant differences in the levels of serum IL-6,IL-8,IL-10,and hsCRP between the AC

关 键 词：中性粒细胞减少 幽门螺杆菌 超敏C反应蛋白 

分 类 号：R557[医药卫生—血液循环系统疾病]