幽门螺杆菌感染与儿童免疫性血小板减少症相关性研究  

Helicobacter pylori infection and immune thrombocytopenia in children

作　　者：张梦[1] 周翾[1] 马静瑶[1] 何雯雯[1] 苏雁[1] 姜锦[1] 张蕊[1] 张莉[1] 杨骏[1] 陈振萍[1] 郑杰[1] 马洁[1] 张利强[1] 吴润晖[1] 

机构地区：[1]首都医科大学附属北京儿童医院血液肿瘤中心,首都医科大学血液学系,100045

出　　处：《中华实用儿科临床杂志》2014年第7期523-526,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81200351）;北京市自然科学基金（7112050、7122065）

摘　　要：【摘要】目的探讨幽门螺杆菌（Hp）感染与儿童免疫性血小板减少症（ITP）发生发展的相关性，为探讨其发病机制和有效治疗方法提供依据。方法顺序收集首都医科大学附属北京儿童医院血液肿瘤中心血液杂病病房2009年5月至2011年12月收治的初次发病ITP患儿临床资料并随访1年以上，入院时常规筛查Hp，根据是否存在Hp感染分为Hp感染组（感染组）与非Hp感染组（非感染组），比较2组：1．发病情况：年龄、性别、出血情况、血小板减少程度；2．ITP治疗效果及疾病转归，分析Hp感染是否为影响ITP远期预后的危险因素；3．分析根除Hp对存在Hp感染病例ITP治疗效果及疾病转归的影响。结果共收集221例初次发病ITP患儿临床资料，感染组52例（23．5％），非感染组169例（76．5％）。1．2组年龄的差异有统计学意义（Z=-4．996，P=0．000），存在Hp感染的ITP患儿年龄偏大；性别、出血情况、血小板减少程度比较差异均无统计学意义（r=0．080、0．459、1．317，P均〉0．05）。2．超过1年随访到173例病例，感染组与非感染组ITP中位完全缓解时间分别为4个月（95％CI1．56—6．44）、2个月（95％CI1．77—2．23），2组完全缓解时间比较差异有统计学意义（，=4．543，P=0．033），提示Hp感染患儿血小板恢复较缓慢。2组ITP疾病转归比较差异有统计学意义（X2=8．574，P=0．036），提示Hp感染患儿易发展为持续性、慢性、复发型ITP。但对2组年龄进行校正后，Hp感染并不影响ITP患儿治疗效果（P=0．900）及疾病转归（P=0．145）。3．超过1年随访到的45例Hp感染患儿，抗Hp治疗后33例Hp根除、12例Hp未根除，比较Hp根除与未根除2组完全缓解及慢性疾病转归（x2=1．452、4．448，P=0．228、0．035），提示根除Hp有利于阻断ITP疾病慢性转归。Hp根除患儿中无ITP复发病例，而未根除患儿中4例（33．3�Objective To investigate the correlation between Helicobacter pylori （Hp） infection and immune thrombocytopenia （ITP）, and to provide the basis to explore its pathogenicity and suggest effective treatment. Methods Clinical data of children with incipient ITP admitted to Hematology-Oncology Center of Beijing Children＇s Hospital Affiliated to Capital Medical University from May 2009 to Dec. 2011 were collected and followed up for at least 1 year. Hp was routinely screened at admission to hospital. According to the occurrence of Hp co-infection, patients were divid- ed into Hp positive group and Hp negative group for observations of： 1. the clinical characteristics ：age,gender,severity of bleeding and level of platelet counts decreased ;2. the treatment response and outcomes of ITP, and further analysis of whether Hp infection was the relevant high risk factor;3, the influence of Hp eradication on the prognosis of ITP. Re- stilts There were 221 cases of first onset ITP,52 cases （23.5%） with Hp infection （ Hp positive group） and 169 ca- ses （76.5%） with out Hp infection （Hp negative group）. 1. There was significant difference between Hp positive group and Hp negative group in ages （Z = -4. 996,P--0. 000）. The patients with Hp infection were older. But there was no difference in gender （X2 = 0. 080 ） , severity of bleeding （X2 = 0. 459 ） and level of platelet counts decreasing （X2 = 1. 317） （ all P 〉0.05）. 2. One hundred and seventy-three cases were followed up for more than 1 year. The me- dian time of complete response in Hp infection group was 4 months（95% CI 1.56 -6.44） ,but was 2 months （95% CI 1.77 - 2.23） in the other group. There was statistical difference in the rate of complete response （X2 = 4. 543,P = 0. 033 ） and chronic disease evolution （X2 = 8. 574 ,P = 0. 036） between Hp positive group and Hp negative group, but there was no difference after the age adjustment （ P 〉 0.05 ）. 3. Forty-five Hp positive ITP cases were followed up m

关 键 词：免疫性血小板减少症 幽门螺杆菌感染 儿童 

分 类 号：R725.5[医药卫生—儿科]