Fujimura Kingo
Graduate School of Biomedical Science, Department of Pharmacotherapy, Division of Hemato/Oncology, Hiroshima University, Hiroshima, Japan.
Int J Hematol. 2005 Feb;81(2):113-8. doi: 10.1532/ijh97.04161.
A treatment strategy for idiopathic thrombocytopenic purpura (ITP) is considered with the aim of cure or management of the bleeding tendency. In 1998, Gasbarrini et al reported a high prevalence of Helicobacter pylori infection in patients with ITP and showed that platelet recovery occurred after eradication therapy in most cases. Since then, many studies were performed to evaluate eradication therapy. This article discusses the incidence of H pylori infection in ITP, characteristic clinical features in H pylori-positive ITP, the effectiveness of eradication on platelet count increase, and the mechanisms of development of ITP by H pylori infection. Overall, there was a positive association between H pylori infection and ITP, and eradication of bacterium was accompanied by a significant increase in platelet counts in more than 50% of H pylori-positive ITP cases. These findings suggest that H pylori infection is involved in the mechanisms of thrombocytopenia in most cases of ITP in middle-aged and older patients. This approach could be beneficial to some ITP patients, but there were some uncertainties raised. To confirm the effectiveness of eradication therapy in H pylori-positive ITP, prospective studies conducted in several countries with a new treatment protocol are required, with a large number of ITP cases and longer follow-up.
针对特发性血小板减少性紫癜（ITP）的治疗策略旨在治愈疾病或控制出血倾向。1998年，加斯巴里尼等人报告ITP患者中幽门螺杆菌感染的患病率很高，并表明在大多数情况下，根除治疗后血小板数量会恢复。从那时起，人们进行了许多研究来评估根除治疗。本文讨论了ITP中幽门螺杆菌感染的发生率、幽门螺杆菌阳性ITP的特征性临床特征、根除治疗对血小板计数增加的有效性以及幽门螺杆菌感染导致ITP的发病机制。总体而言，幽门螺杆菌感染与ITP之间存在正相关，在超过50%的幽门螺杆菌阳性ITP病例中，根除细菌伴随着血小板计数的显著增加。这些发现表明，在大多数中老年ITP病例中，幽门螺杆菌感染参与了血小板减少的机制。这种方法可能对一些ITP患者有益，但也引发了一些不确定性问题。为了证实根除治疗对幽门螺杆菌阳性ITP的有效性，需要在几个国家采用新的治疗方案进行前瞻性研究，纳入大量ITP病例并进行更长时间的随访。
