Ahn Eugene R, Tiede Maike P, Jy Wenche, Bidot Carlos J, Fontana Vincenzo, Ahn Yeon S
Wallace H. Coulter Platelet Laboratory, Division of Hematology/Oncology, UM Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA.
Acta Haematol. 2006;116(1):19-24. doi: 10.1159/000092343.
It has been suggested that Helicobacter pylori eradication often increases platelet counts in patients with chronic idiopathic thrombocytopenic purpura (ITP). In addition, H. pylori has been shown to induce platelet activation (CD62p or P-selectin expression) in previous studies. We assessed the response of platelet count and CD62p expression after eradication therapy in patients with ITP and H. pylori infection.
We prospectively studied 15 ITP patients diagnosed with H. pylori infection by serology and breath test. A follow-up breath test was used to document eradication. Two out of 15 patients showed improvement in platelet counts after 6 months, 1 of which may have had drug-induced thrombocytopenia. Overall, certain platelet response rate in our series was 6.7% (1/15). We found that platelet CD62p expression by flow cytometry was elevated in 10/15 (66.7%) H. pylori-infected patients, which is a statistically significant difference when compared with 3/33 (9.1%) control ITP patients seronegative for H. pylori (p = 0.002). In addition, eradication therapy decreased CD62p expression (p = 0.04). However, reduction in platelet activation was not associated with an increase in platelet counts (mean 72.4 x 10(9)/l before and 68.7 after therapy; p = 0.4).
In our series, platelet activation was common in ITP patients with H. pylori, and eradication therapy decreased platelet activation but seldom increased platelet counts. Increased platelet CD62p expression is a putative link between chronic infections and atherosclerosis, but further study is needed to clarify the implications of our observation.
有研究表明，根除幽门螺杆菌通常会使慢性特发性血小板减少性紫癜（ITP）患者的血小板计数增加。此外，在先前的研究中已显示幽门螺杆菌可诱导血小板活化（CD62p或P-选择素表达）。我们评估了ITP合并幽门螺杆菌感染患者根除治疗后血小板计数和CD62p表达的反应。
我们前瞻性地研究了15例经血清学和呼气试验诊断为幽门螺杆菌感染的ITP患者。采用随访呼气试验记录根除情况。15例患者中有2例在6个月后血小板计数有所改善，其中1例可能患有药物性血小板减少症。总体而言，我们系列研究中的特定血小板反应率为6.7%（1/15）。我们发现，通过流式细胞术检测，15例幽门螺杆菌感染患者中有10例（66.7%）血小板CD62p表达升高，与33例幽门螺杆菌血清阴性的对照ITP患者中的3例（9.1%）相比，差异具有统计学意义（p = 0.002）。此外，根除治疗降低了CD62p表达（p = 0.04）。然而，血小板活化的降低与血小板计数的增加无关（治疗前平均为72.4×10⁹/L，治疗后为68.7×10⁹/L；p = 0.4）。
在我们的系列研究中，血小板活化在合并幽门螺杆菌感染的ITP患者中很常见，根除治疗降低了血小板活化，但很少增加血小板计数。血小板CD62p表达增加是慢性感染与动脉粥样硬化之间的一个假定联系，但需要进一步研究以阐明我们观察结果的意义。
