特发性血小板减少性紫癜与幽门螺杆菌感染的相关性研究

目的研究特发性血小板减少性紫癜(ITP)与幽门螺杆菌(Hp)感染的相关性,观察抗Hp治疗对难治性ITP的疗效。方法对中国医科大学附属第一医院血液科2002年11月至2005年5月收治的48例ITP患者进行研究,正常对照组52例,因消化系统症状行胃镜和其他相关检查但未见明显异常的门诊患者。采用13C-尿素呼气试验及Hp血清抗体联合诊断Hp感染。对11例Hp感染阳性的难治性ITP患者抗Hp治疗,采用经典的三联药物,具体为奥美拉唑20mg口服,每日2次;克拉霉素500mg口服,每日2次;阿莫西林1g口服,每日2次,连用7d,4~8周后复查13C-尿素呼气试验、Hp血清抗体、血小板计数和血小板抗体。结果ITP组和正常对照组的Hp感染阳性率分别为68.18%(33/48),46.12%(24/52),ITP组Hp阳性率显著升高(P<0.05);11例常规治疗无效或复发患者并伴有Hp感染,有8例经上述治疗Hp感染转为阴性,该8例4~8周后血小板计数显著升高,其中6例血小板自身抗体消失,而Hp检测阴性患者和Hp感染未得以根治的患者随访时血小板抗体和血小板计数均无变化。结论ITP患者Hp感染阳性率高于正常人;对于Hp感染阳性的难治性ITP患者,根除Hp的方法治疗ITP是行之有效的。     

特发性血小板减少性紫癜的病因及疗效探讨

目的 :探讨特发性血小板减少性紫癜 (ITP)的病因与疗效的关系。方法 :对 16 0例ITP患者的临床及实验室资料进行回顾分析 ,分 4组采取 4种治疗方法 :A组 :抗幽门螺旋杆菌 (HP)加地塞米松冲击继之泼尼松治疗 ;B组 :泼尼松加大剂量丙种球蛋白冲击治疗 ;C组 :泼尼松加达那唑治疗 ;D组 :难治性的给以睥切除治疗。按显效、良效、有效、无效评价治疗效果。结果 :急性ITP 90例 ,慢性ITP 70例 ,男 5 5例 ,女 10 5例 ,男女之比为 1∶2 ,就诊时中位年龄 39岁 ,均有出血表现 ,中位PLT数 15× 10 9/L。有HP感染 75例 ,血小板表面抗体 (PAIGg)阳性 90例 ;血小板自身抗体阳性 30例 ;骨髓巨核细胞增多 114例 ,正常 35例 ,减少 10例 ,巨核细胞均以颗粒巨核细胞为主。T细胞亚群分布以CD4 /CD8降低为主。 4种治疗效果以抗HP加地塞米松冲击继之泼尼松治疗和泼尼松加大剂量丙种球蛋白冲击治疗为好 ,泼尼松加达那唑治疗次之。前两种治疗与后两种之间差异有统计学意义 ,均 P <0 .0 1。结论 :HP感染及自身免疫因素的异常是ITP发病的直接病因。抗HP、激素、大剂量丙种球蛋白是较理想的治疗选择     

血小板减少性紫癜230例临床分析

目的：探讨血小板减少性紫癜的病因,ITP的临床特征和治疗效果,为血小板减少性紫癜的诊断和治疗提供参考。方法：回顾性分析230例血小板减少性紫癜(包括192例ITP、17例Evans综合征和21例继发性血小板减少性紫癜)患者的临床资料。结果：192例ITP患者中有明确发病诱因者45例(23．3%),以呼吸道感染和病毒感染为主;102例ITP患者中66例(占64．7%)抗体阳性(ANA34例,抗SSA 17例,抗SSB 3例,抗SCL-70 1例,IgG升高11例),13例关节受累患者中10例风湿抗体阳性,血小板计数与糖皮质激素治疗有效率之间无相关性;4例初诊ITP患者在随访过程中被证实为继发性血小板减少性紫癜(胃癌1例,化脓性扁桃体炎1例,结缔组织病2例)。结论：应积极寻找并去除血小板减少性紫癜的病因及诱因,注意排除结缔组织病、肿瘤等引起的继发性血小板减少症。     

HP感染与ITP的相关性分析

目的分析幽门螺旋杆菌感染(HP)与免疫性血小板减少症(ITP)之间存在的关系。方法将2013年2月—2015年2月收治的168例ITP患者作为研究的对象(观察组),另取同期来我院接受检查的168例健康体检者作为纳入对照(对照组),对两组感染幽门螺旋杆菌的发生率进行对比评价。结果观察组168例ITP患者中,感染幽门螺旋杆菌70例,感染率为41.67%;对照组健康体检者中,感染幽门螺旋杆菌(HP)32例,感染率为19.05%。在幽门螺旋杆菌感染率方面,观察组与对照组相比明显要高(P0.05)。结论幽门螺旋杆菌感染易导致免疫性血小板减少性紫癜发生;针对ITP患者,在明确感染幽门螺旋杆菌的情况下,需积极采取抗幽门螺旋杆菌感染治疗,进而确保患者获得优化治疗。     

大剂量丙种球蛋白治疗成人特发性血小板减少性紫癫的临床疗效

本文探讨成人特发性血小板减少性紫癜(ITP)患者用7S-丙种球蛋白制剂治疗的效果,及其对血小板相关免疫球蛋白G(PAIgG)和血小板功能的影响。本组18例,其中男7、女11例,年龄18～74岁。急性ITP 2例;慢性ITP16例,其中4例已行脾切除术。全部患者均给予免疫球蛋白0.4g/kg静脉注射,连用5天为1个疗程,其中6例使用过2个疗程。如以血小板数升高至少为治疗前的两倍,总数不少于5万/mm~3为治疗有效,则2例急性ITP中有1例、12例慢性ITP未行脾切除者中有7例、4例慢性ITP已行脾切除者全部治疗有效。于治疗后第4～5天血小板数达到峰值。1例急性ITP完全缓解;慢性型的疗效是暂时的,持续18～25天。5例接     

特发性血小板减少性紫癜与幽门螺杆菌的关系

目的:探讨特发性血小板减少性紫癜(ITP)与幽门螺杆菌(Hp)的关系。方法:对33例ITP患者进行Hp的检测,并进行抗Hp的治疗,观察血小板的恢复情况。结果:Hp阳性的ITP患者,经抗Hp治疗后Hp阴转者的疗效好于未阴转及Hp阴性的患者。结论:Hp感染可能是ITP的发病原因之一。     

免疫性血小板减少性紫癜伴幽门螺杆菌感染相关性调查

目的:探讨免疫性血小板减少性紫癜(ITP)患者伴幽门螺杆菌(HP)感染情况,及根除HP治疗对ITP患者的疗效影响。方法:242例ITP患者与240例健康体检者进行HP抗体检测,对HP感染率及OR值进行分析。然后对116例HP感染的ITP患者依据是否根除HP治疗再分组,其中56例进行了常规治疗,另外60例进行了常规治疗联合根除HP治疗,对2组患者的总有效率与1年期复发率进行对比。结果:ITP患者HP感染率明显高于健康体检者(47.9%∶23.8%,P0.05);OR=2.956,说明HP感染(暴露)使ITP发病危险度增加,是疾病的危险因素。联合根除HP治疗者的总有效率明显高于常规治疗者(86.7%∶69.7%,P0.05),1年期总复发率明显低于常规治疗者(18.3%∶35.7%,P0.05)。结论:HP感染与ITP具有一定的相关性,ITP患者应常规进行HP筛查,HP感染的ITP患者应规范根除HP治疗,以提高患者治疗有效率、降低复发率。     

乙肝病毒感染与免疫性血小板减少症的临床研究

目的:分析我地区免疫性血小板减少症(ITP)患者的乙肝病毒感染状态与ITP临床相关性,提供合理的治疗方案。方法:收集2016-08-2019-08在我院住院的ITP患者93例,对其中64例患者给予糖皮质激素或联合免疫球蛋白治疗,分析所有患者的临床特征,并对64例糖皮质激素治疗患者的疗效影响因素进行分析。结果:我地区ITP患者乙肝核心抗体阳性率高于同期住院患者(46.2%vs 18.7%,P=0.004);对于疗效和血小板恢复时间,乙肝感染状态是独立影响因素(P0.05)。结论:我地区ITP患者存在乙肝隐匿性感染可能,对于乙肝核心抗体阳性的ITP患者糖皮质激素疗效不佳,可尽早应用血小板生成素二线治疗。     

PCI围手术期清除幽门螺杆菌感染对降低上消化道出血风险的研究

目的探讨PCI围手术期患者感染幽门螺杆菌与上消化道出血的关系。方法选取2011年5月~2014年5月在我院行经皮冠状动脉介入治疗(PCI)治疗的患者1600例为研究对象,在PCI术后进行幽门螺旋杆菌(HP)检测,根据检测结果将患者分为HP阳性对照组、HP阳性治疗组和HP阴性组,HP阳性治疗组为根治HP,HP阳性对照组为常规治疗,并随访观察三组患者消化道出血情况。结果治疗后,HP阳性治疗组消化道出血发生率明显低于HP阳性对照组;HP阳性治疗组选取患者460例,1年内消化道出血13例(2.83%);HP阳性对照组随机选取患者468例,消化道出血48例(10.25%);差异均有统计学意义(P0.05)。HP阴性组患者488例,消化道出血27例(5.53%)。结论 PCI需服用术后二联抗血小板聚集药物,可增加HP阳性患者消化道出血的风险,根治HP感染后,明显降低PCI患者消化道出血的风险,且改善PCI患者近远期预后效果,值得临床应用。     

大剂量地塞米松联合长春新碱治疗慢性难治性特发性血小板减少性紫癜的临床观察

特发性血小板减少性紫癜(ITP)是一种自身免疫性疾病。一线治疗以口服泼尼松为主。对此疗法无效或须长时间大剂量糖皮质激素才能维持血小板计数在安全水平,称为慢性难治性ITP。2003年4月以来,我们采用短期间断大剂量地塞米松联合长春新碱的方法治疗难治性慢性ITP8例,疗效较好,现报道如下:资料与方法一般资料患者8例,符合张之南主编《血液病诊断和疗效判断标准》ITP诊断标准。男3例,女5例,年龄21～52岁,平均34.2岁;病程1.5～23年,平均5.1年。8例均口服(泼尼松)常规剂量无效、无糖皮质激素依赖者,均未行脾脏切除术。治疗前血小板计数维持…     

Efficacy of Helicobacter pylori eradication in raising platelet count in adult patients with idiopathic thrombocytopenic purpura

BACKGROUND AND OBJECTIVES: There are data consistent with an association between idiopathic thrombocytopenic purpura (ITP) and Helicobacter pylori (HP) infection. In addition, a significant increase of platelet count following HP eradication has been reported in a proportion of ITP patients. We describe here our experience on the efficacy of anti-HP treatment in ITP patients. DESIGN AND METHODS: Between December 1998 and May 2001 sixteen adult patients with ITP and documented HP infection were treated with standard antibiotic therapy for HP eradication (amoxicillin and clarithromycin plus pantoprazole combination). Of these patients, 7 had untreated ITP with mild/moderate thrombocytopenia (median platelet count 70x10(9)/L, range 41-91), 5 had relapsed following a previous steroid treatment (median platelet count 39x10(9)/L, range 30-90) and 4 were refractory to steroids (median platelet count 18.5x10(9)/L, range 9-30). RESULTS: An improvement of platelet count was observed in 11/15 patients (73.3%) who achieved HP eradication. The difference between the mean platelet count SD before and after HP eradication was statistically significant (51.6 28.2x10(9)/L vs. 143.3 131.1x10(9)/L; p=0.01). Complete or partial responses were obtained in 11/16 treated patients (68.7%). This result still persisted after a median follow-up of 11.7 months. INTERPRETATION AND CONCLUSIONS: Our data confirm the efficacy of Helicobacter pylori eradication in increasing platelet count in adult ITP patients.     

Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura

The prevalence of Helicobacter pylori infection and the effect of its eradication on platelet count in 48 Japanese patients with autoimmune thrombocytopenic purpura (AITP), including 40 chronic idiopathic thrombocytopenic purpura (ITP) and eight secondary AITP, were investigated. H. pylori infection was found in 25 ITP patients (62.5%) and in two secondary AITP (25%). H.pylori eradication was obtained in 19 of 19 infected ITP patients (100%), who were not in remission (platelets < 100 x 109/l) at the time of infection assessment. During follow-up (median 14.8 months), 12 of 19 H. pylori-eradicated patients (63.2%) showed a significant increase in platelet count accompanied by a significant decrease of platelet-associated immunoglobulin G (IgG). This response was maintained in all responding patients throughout the follow-up period. However, two infected patients with secondary AITP did not show platelet increase after eradication. The assessment of H. pylori infection and its eradication should be attempted in ITP as this approach could be an effective strategy, at least for some of these patients.     

Helicobacter pylori-associated immune thrombocytopenia

Idiopatic thrombocytopenic purpura (ITP), a disorder characterized by autoantibody-mediated platelet destruction, may be primary or secondary to various illnesses including lymphoproliferative, autoimmune, or infectious diseases. There are increasing data on the association between Helicobacter pylori infection and idiopathic thrombocytopenic purpura and the significant increase in platelet count after bacterial eradication. The aim of this review is to consider the studies so far published on Helicobacter pylori infection and idiopathic thrombocytopenic purpura in order to evaluate a possible pathogenic correlation between these two conditions. A review of the literature data show that Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura is effective in increasing platelet count in approximately half of the cases. However, since the studies so far published are few, sometimes controversial and involve small series of patients, further controlled studies on larger numbers of patients with longer follow-up are needed to confirm these preliminary findings.     

Effect of eradication of Helicobacter pylori on platelet recovery in patients with chronic idiopathic thrombocytopenic purpura: a controlled trial

Several recent studies have suggested that an association exists between Helicobacter pylori (HP) eradication and improvement in platelet count in a significant proportion of patients with idiopathic thrombocytopenic purpura (ITP). In this controlled study, we prospectively examined adult patients with chronic ITP for HP infection, and assessed the effect of HP eradication on platelet count. One hundred forty-two consecutive Iranian patients with chronic ITP were assessed. Those who met the criteria and had platelet counts >30 x 10(9)/L within the medication-free screening month were enrolled (n = 129; 66 females; mean age, 29.2 +/- 7.0 years). HP-positive patients received a 2-week course of triple HP eradication therapy (i.e., amoxicillin, clarithromycin, and omeprazole) and were followed for 48 weeks. An ITP response was defined as a platelet count of >100 x 10(9)/L 24 weeks after treatment, together with an increase in the platelet count >30 x 10(9)/L over the baseline value. HP infection was detected in 79 (61%) patients. HP-positive patients were significantly older than HP-negative subjects (P = 0.018). HP eradication was successful in 87% (62/71) of those who completed the eradication therapy. Whereas 48% (30/62) of HP-eradicated patients showed an ITP response, no HP-negative patient had an ITP response. The ITP response persisted for 48 weeks in 93% (28/30) of the responders. The ITP responders had a shorter disease duration than the nonresponders (P = 0.002). The management of mild-to-moderate chronic ITP in Iranian patients, especially those with a recent onset of disease, should include an investigation for and eradication of infection with HP.     

Effect of Helicobacter pylori eradication on platelet recovery in patients with chronic idiopathic thrombocytopenic purpura

BACKGROUND: A relationship between Helicobacter pylori infection and idiopathic thrombocytopenic purpura (ITP) has previously been reported. We determined the prevalence of H pylori infection in Japanese patients with chronic ITP and the effect of its eradication on platelet count. METHODS: The study population comprised 53 Japanese adults with chronic ITP and a platelet count of less than 100 x 10(3)/ micro L. A (13)C-urea breath test was performed to determine H pylori infection status. Those patients who were H pylori positive gave written informed consent and received eradication therapy. The effect of H pylori eradication on platelet count was evaluated up to 6 months after therapy. Clinical parameters were compared between responders to the therapy (increase in platelet count) and nonresponders, as well as between H pylori-positive and -negative patients. RESULTS: Of the 53 patients with chronic ITP in the study, 39 (74%) were H pylori positive. Of the 32 infected patients who received treatment, H pylori was successfully eradicated in 27 patients (84%). In 10 (37%) of these patients, this resulted in a favorable platelet response. A partial response was seen in 5 additional patients (19%). A significant (P<.001) increase in platelet count was demonstrated in patients in whom H pylori was successfully eradicated but not in patients who were unsuccessfully treated or in untreated patients. Current corticosteroid therapy was reported more often in nonresponders than in responders. CONCLUSION: Eradication of H pylori may prove effective in increasing platelet count in H pylori-positive patients with chronic ITP.     

Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura--the associateion between the activity of Helicobacter pylori and platelet recovery

We investigated the prevalence of Helicobacter pylori infection and the effect of eradication therapy in patients with idiopathic thrombocytopenic purpura (ITP). H. pylori infection was found in 9 of 11 patients (81.8%). H. pylori eradication was obtained in all patients and significant platelet recovery was found in 5 of 9 patients (55.6%). One patient required re-eradication therapy because the urea breath test remained positive after the first therapy. After complete eradication, long time remission was obtained. The results suggested that the platelet count might be correlated closely with the amount of H. pylori in some patients with H. pylori positive ITP.     

Purification of Placenta-Eluted Gamma Globulins and Their Strong Effect against Graft-versus-Host Reactions In Vitro and In Vivo

A retrospective study was performed to determine the prevalence of Helicobacter pylori (H pylori) infection, the effect of H pylori eradication on platelet counts, and the characteristic clinical features of chronic immune or idiopathic thrombocytopenic purpura (ITP) with H pylori infection. H pylori infection was found in 300 patients, a group that was significantly older (P < .005) and had more cases of hyperplastic megakaryocytes in the bone marrow (P = .01) than patients without H pylori infection. H pylori eradication therapy was performed in 207 H pylori-positive ITP cases, and the platelet count response was observed in 63% of the successful eradication group and in 33% of the unsuccessful eradication group (P < .005). In the successful group, the complete remission and partial remission rates were 23% and 42%, respectively, 12 months after eradication. In the majority of responders, the platelet count response occurred 1 month after eradication therapy, and the increased platelet count continued without ITP treatment for more than 12 months. H pylori eradication therapy was effective even in refractory cases, which were unresponsive to splenectomy. In conclusion, H pylori infection was involved in most ITP patients older than 40 years in Japan, and eradication therapy should be the first line of treatment in H pylori-positive ITP patients.     

Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura

PURPOSE: To investigate the relation between Helicobacter pylori infection and the clinical features of idiopathic thrombocytopenic purpura (ITP), and to examine the effects of H. pylori eradication on platelet counts. METHODS: A(13)C urea breath test for H. pylori infection was performed in a cohort of 137 consecutive patients with ITP. Patients who tested positive received standard eradication therapy if their platelet count was <50 x 10(9)/L or if they had symptoms of dyspepsia. RESULTS: H. pylori infection was detected in 64 patients (47%), and was not associated with dyspepsia or other clinical or laboratory features. Eradication therapy was successfully administered to 52 patients. Platelet responses were observed in 17 (33%) of these patients, which lasted for more than 1 year in 11 patients. Duration of ITP was shorter among responders than nonresponders. Only one response was observed among patients with severe thrombocytopenia (platelet count <30 x 10(9)/L). CONCLUSION: The prevalence of H. pylori infection in patients with ITP is similar to that found in the general population. Infection is not associated with distinctive features of the disease. H. pylori eradication may improve the platelet counts in adults in whom the ITP is of recent onset and in those with less severe degrees of thrombocytopenia, but was not effective in patients with chronic severe ITP.     

High prevalence of sustained remission of idiopathic thrombocytopenic purpura after Helicobacter pylori eradication: a long-term follow-up study

We studied the effect of Helicobacter pylori (H. pylori) eradication in 43 consecutive H. pylori-infected patients with idiopathic thrombocytopenic purpura. H. pylori was eradicated with antibiotics in 41 of them (95.3%). The difference between the mean platelet count before and after therapy was statistically significant (54.3 x 10(9)/l vs. 119.1 x 10(9)/l; P < 0.001). A sustained remission was observed in 20 patients (48.8%), after a median follow-up of 31.2 months. None of the patients still infected by H. pylori after therapy reached normal platelet values. The long-term follow-up confirms the efficacy of H. pylori eradication in H. pylori-infected ITP patients.     

幽门螺杆菌感染与特发性血小板减少性紫癜关系的荟萃分析

目的:评价特发性血小板减少性紫癜(ITP)与幽门螺杆菌(H pylori )感染的相关性.方法:检索PubMed、EMBase和CNKI数据库,获取ITP与H pylori 感染的病例-对照研究, 将入选的病例分成4组:H pylori 阳性并成功清除组; H pylori 阳性但清除不成功组; H pylori 阳性未清除治疗组; H pylori 阴性组. 每组均记录进入实验时各患者的基础血小板计数和随访时的血小板计数, 并在组内行荟萃分析.结果:检索文献中纳入21篇病例-对照研究, 其中国外17篇, 国内4篇. 在随访前后, H pylori阳性并成功清除组P LT计数有统计学意义(WMD 61.70, 95%CI:47.58-75.81); H pylori阳性但清除不成功组PLT计数无统计学意义(WMD 11.41, 95%CI:-0.07-22.88); H pylori阳性未清除治疗组P LT计数无统计学意义(WMD 15.77, 95%CI:-7.99-39.54); H pylori阴性组PLT计数有统计学意义(WMD 24.24,95%CI:8.54-39.93).结论:H pylor i 阳性的ITP患者在成功清除H pylori 后PLT计数上升, 但H pylori 感染并不是ITP发生的唯一因素.