中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
7期
523-526
,共4页
张梦%周翾%马静瑶%何雯雯%苏雁%姜锦%张蕊%张莉%杨骏
張夢%週翾%馬靜瑤%何雯雯%囌雁%薑錦%張蕊%張莉%楊駿
장몽%주현%마정요%하문문%소안%강금%장예%장리%양준
免疫性血小板减少症%幽门螺杆菌感染%儿童
免疫性血小闆減少癥%幽門螺桿菌感染%兒童
면역성혈소판감소증%유문라간균감염%인동
Immune thrombocytopenia%Helicobacter pylori infection%Child
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(x2=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% CI 1.56~ 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(x2 =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%,4/12例)ITP复发.结论 虽然受Hp感染流行病学特点影响,存在Hp感染的ITP患儿发病年龄偏大,但Hp感染患儿在发病性别、出血情况、血小板减少程度方面与非感染患儿无区别;经过年龄因素校正后Hp感染并非影响ITP患儿治疗效果及疾病转归的危险因素,但根除Hp有助于减少存在Hp感染ITP患儿的慢性疾病转归、减少复发.
目的 探討幽門螺桿菌(Hp)感染與兒童免疫性血小闆減少癥(ITP)髮生髮展的相關性,為探討其髮病機製和有效治療方法提供依據.方法 順序收集首都醫科大學附屬北京兒童醫院血液腫瘤中心血液雜病病房2009年5月至2011年12月收治的初次髮病ITP患兒臨床資料併隨訪1年以上,入院時常規篩查Hp,根據是否存在Hp感染分為Hp感染組(感染組)與非Hp感染組(非感染組),比較2組:1.髮病情況:年齡、性彆、齣血情況、血小闆減少程度;2.ITP治療效果及疾病轉歸,分析Hp感染是否為影響ITP遠期預後的危險因素;3.分析根除Hp對存在Hp感染病例ITP治療效果及疾病轉歸的影響.結果 共收集221例初次髮病ITP患兒臨床資料,感染組52例(23.5%),非感染組169例(76.5%).1.2組年齡的差異有統計學意義(Z=-4.996,P=0.000),存在Hp感染的ITP患兒年齡偏大;性彆、齣血情況、血小闆減少程度比較差異均無統計學意義(x2=0.080、0.459、1.317,P均>0.05).2.超過1年隨訪到173例病例,感染組與非感染組ITP中位完全緩解時間分彆為4箇月(95% CI 1.56~ 6.44)、2箇月(95%CI1.77 ~2.23),2組完全緩解時間比較差異有統計學意義(x2 =4.543,P =0.033),提示Hp感染患兒血小闆恢複較緩慢.2組ITP疾病轉歸比較差異有統計學意義(x2=8.574,P=0.036),提示Hp感染患兒易髮展為持續性、慢性、複髮型ITP.但對2組年齡進行校正後,Hp感染併不影響ITP患兒治療效果(P =0.900)及疾病轉歸(P=0.145).3.超過1年隨訪到的45例Hp感染患兒,抗Hp治療後33例Hp根除、12例Hp未根除,比較Hp根除與未根除2組完全緩解及慢性疾病轉歸(x2=1.452、4.448,P=0.228、0.035),提示根除Hp有利于阻斷ITP疾病慢性轉歸.Hp根除患兒中無ITP複髮病例,而未根除患兒中4例(33.3%,4/12例)ITP複髮.結論 雖然受Hp感染流行病學特點影響,存在Hp感染的ITP患兒髮病年齡偏大,但Hp感染患兒在髮病性彆、齣血情況、血小闆減少程度方麵與非感染患兒無區彆;經過年齡因素校正後Hp感染併非影響ITP患兒治療效果及疾病轉歸的危險因素,但根除Hp有助于減少存在Hp感染ITP患兒的慢性疾病轉歸、減少複髮.
목적 탐토유문라간균(Hp)감염여인동면역성혈소판감소증(ITP)발생발전적상관성,위탐토기발병궤제화유효치료방법제공의거.방법 순서수집수도의과대학부속북경인동의원혈액종류중심혈액잡병병방2009년5월지2011년12월수치적초차발병ITP환인림상자료병수방1년이상,입원시상규사사Hp,근거시부존재Hp감염분위Hp감염조(감염조)여비Hp감염조(비감염조),비교2조:1.발병정황:년령、성별、출혈정황、혈소판감소정도;2.ITP치료효과급질병전귀,분석Hp감염시부위영향ITP원기예후적위험인소;3.분석근제Hp대존재Hp감염병례ITP치료효과급질병전귀적영향.결과 공수집221례초차발병ITP환인림상자료,감염조52례(23.5%),비감염조169례(76.5%).1.2조년령적차이유통계학의의(Z=-4.996,P=0.000),존재Hp감염적ITP환인년령편대;성별、출혈정황、혈소판감소정도비교차이균무통계학의의(x2=0.080、0.459、1.317,P균>0.05).2.초과1년수방도173례병례,감염조여비감염조ITP중위완전완해시간분별위4개월(95% CI 1.56~ 6.44)、2개월(95%CI1.77 ~2.23),2조완전완해시간비교차이유통계학의의(x2 =4.543,P =0.033),제시Hp감염환인혈소판회복교완만.2조ITP질병전귀비교차이유통계학의의(x2=8.574,P=0.036),제시Hp감염환인역발전위지속성、만성、복발형ITP.단대2조년령진행교정후,Hp감염병불영향ITP환인치료효과(P =0.900)급질병전귀(P=0.145).3.초과1년수방도적45례Hp감염환인,항Hp치료후33례Hp근제、12례Hp미근제,비교Hp근제여미근제2조완전완해급만성질병전귀(x2=1.452、4.448,P=0.228、0.035),제시근제Hp유리우조단ITP질병만성전귀.Hp근제환인중무ITP복발병례,이미근제환인중4례(33.3%,4/12례)ITP복발.결론 수연수Hp감염류행병학특점영향,존재Hp감염적ITP환인발병년령편대,단Hp감염환인재발병성별、출혈정황、혈소판감소정도방면여비감염환인무구별;경과년령인소교정후Hp감염병비영향ITP환인치료효과급질병전귀적위험인소,단근제Hp유조우감소존재Hp감염ITP환인적만성질병전귀、감소복발.
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 Mcdical University from May 2009 to Dec.2011 were collected and followed up for at lcast 1 year.Hp was routinely screened at admission to hospital.According to the occurrence of Hp co-infection,patients were divided 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.Results There were 221 cases of first onset ITP,52 cases (23.5%) with Hp infection (Hp positive group) and 169 cases (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 median 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 more for than 1 year.After Hp eradication treatment,33 cases succeeded,but 12 cases failed.The outcomes of ITP was statistically different between Hp eradicated group and Hp un-eradicated group (x2 =4.448,P =0.035),but there was no statistical difference in therapeutic response between them(x2 =1.452,P =0.228).There was no recurrent ITP case in the 33 children with Hp eradication,but 4 recurrent cases(33.3%,4/12 cases)were found in the 12 un-eradicated cases.The results suggested that Hp eradication therapy did not obviously enhance the therapeutic effect on children with ITP,but could be helpful to shorten the duration of ITP and decrease the relapse rate.Conclusions Although affected by the epidemiology of Hp infection,the ITP children with Hp infection are older,and the other characteristics like gender,severity of bleeding and level of platelet counts decreasing between the groups with and without Hp infection have no difference.And after the age adjustment,Hp infection is not the risk factor for the worse result and progress of ITP children,but the Hp eradication can be helpful in the reduction of ITP chronic progress and relapse.