幽门螺杆菌检测在免疫性血小板减少症治疗中的临床意义

目的探讨幽门螺杆菌（HP）对免疫性血小板减少症（ITP）治疗效果的影响。方法113例成人初诊ITP患者分为HP检测组52例（检测组）、HP未检测组61例（未检测组），^14C呼气试验对检测组52例进行HP检测后分为HP（＋）组、HP（-）组。所有患者给予糖皮质激素泼尼松进行ITP治疗（1mg·kg^-1·d^-1，顿服），检测组中HP（＋）患者同时给予抗HP治疗（三联方案，阿莫西林0．5g，bid；奥美拉唑20mg，bid；克林霉素0．5g，bid）。检测不同时点患者血小板计数、CD8淋巴细胞，治疗6个月后评价各组治疗效果。结果113例患者的总有效率为70．80％，未检测组为55．74％，检测组为88．46％（P〈0．05）。检测组中，HP（-）和HP（＋）在治疗2周后血小板计数显著上升，与治疗前及治疗1周时血小板计数比较差异具有统计学意义（P〈0．05）；HP（-）和HP（＋）的治疗有效率及复发率均无统计学差异。未检测组治疗2周后血小板计数与治疗前及治疗1周时比较亦升高，但明显低于检测组（P〈0．05）；6个月复发率增高（P〈0．05）。检测组中，HP（＋）组治疗前CD8比例增高比率大于HP（-）组，治疗后CD8比例恢复率亦大于HP（-）组。未检测组CD8比例增高率及CD8比例恢复率与检测组总体无差别（P〉0．05）。结论HP阳性在ITP中有较高的发生率，对于HP阳性患者进行抗HP治疗可以显著提高ITP疗效。

Clinical application of Helicobacter pylori detection to treat immune thrombocytopenia

Objective To assess the effect of Helicobacter pylori （HP） on the treatment of immune thrombocytope- nia （ITP）. Methods A total of 113 adult patients diagnosed with immune thrombocytopenia were divided into two groups, according to HP detection. For 52 patients receiving the detection, they were also divided into an HP （ ＋ ） group and an HP （ - ） group according to the results of 14C breath test. All patients were treated using 1 mg/kg of prednisone per day, while those in the HP （ ＋ ） group were also given a triple therapy, using 0.5 g amoxicillin, 20 mg omeprazole and 0.5 g clindamycin （bid） against HP. The peripheral blood of all patients were sampled for testing platelet counts and T lymphocyte subsets by flow cytometry at different time points. Meanwhile, therapeutic efficacy was assessed six months after treatment. Results The total effective rate was 70.80%, with an effective rate of 55.74% for the non - testing group and 88.64% for the testing group （P 〈 0.05 ）. For the testing group, no statistical difference was found between HP （ ＋ ） and HP （ - ） patients as to the effective rate and recurrence rate . The non - testing group produced higher a- mounts of PLT two weeks after treatment than the levels before and one week after treatment, which however was still re- markably lower than that of the testing group （ P 〈 0.05 ）, and an increased recurrence rate six months after treatment （P 〈 0.05）. For patients without HP in the testing group, HP carriers showed a higher elevation in CD8 percentage before treatment and an improved recovery in CD8 percentage after treatment. Moreover, no statistical difference was found as to the elevation and recovery of CD8 percentage between the testing and non - testing groups （ P 〉 0.05 ）. Conclusion The infective rate of HP is higher among ITP patients. HP treatment can be applied for ITP patients carrying HP, so as to im- prove the efficacy of ITP.