Franchini Massimo, Cruciani Mario, Mengoli Carlo, Pizzolo Giovanni, Veneri Dino
Immuno-Hematology and Transfusion Center, City Hospital, Verona, and Department of Histology, Microbiology, and Medical Biotechnology, University of Padua, Italy.
J Antimicrob Chemother. 2007 Aug;60(2):237-46. doi: 10.1093/jac/dkm195. Epub 2007 Jun 7.
There is a debate in the recent literature about the effect of Helicobacter pylori eradication on platelet count in patients with idiopathic thrombocytopenic purpura (ITP). In order to clarify this controversial issue, we performed a systematic review with meta-analysis of the available literature.
The meta-analytic comparison was focused on the difference in the platelet count increase between the experimental arm (H. pylori-infected patients who responded to eradication therapy) and each control arm (H. pylori-infected patients who failed to respond to eradication therapy; H. pylori-infected patients who did not receive eradication therapy and H. pylori-negative patients) and was expressed as weighted mean difference (WMD). Moreover, in order to explain the heterogeneity, a meta-regression model was fitted with arm-level covariates.
Data involving 788 ITP patients were collected from 17 articles (16 studies with a prospective cohort design and 1 randomized trial). There was a statistically significant difference in the increase in platelet count in patients in whom eradication was successful compared with control groups [WMD, 40.77x10(9)/L (95% CI, 20.92-60.63) compared with untreated patients; 52.16 (95% CI, 34.26-70.05) compared with patients who failed eradication and 46.35 (95% CI, 27.79-64.91) compared with H. pylori-negative patients]. Moreover, in the meta-regression model, the success of H. pylori eradication was highly significant as an explanatory variable for platelet count increase.
Our analysis shows a strict correlation between H. pylori eradication and increase in platelet count. However, due to intrinsic limits in the design of the studies analysed, further evidence from randomized clinical trials is required to confirm the effect of eradication treatment on platelet count.
近期文献中对于幽门螺杆菌根除治疗对特发性血小板减少性紫癜（ITP）患者血小板计数的影响存在争议。为阐明这一有争议的问题，我们对现有文献进行了系统综述和荟萃分析。
荟萃分析比较聚焦于试验组（对根除治疗有反应的幽门螺杆菌感染患者）与各对照组（对根除治疗无反应的幽门螺杆菌感染患者；未接受根除治疗的幽门螺杆菌感染患者以及幽门螺杆菌阴性患者）之间血小板计数增加的差异，并以加权平均差（WMD）表示。此外，为解释异质性，采用包含组水平协变量的荟萃回归模型。
从17篇文章（16项前瞻性队列研究和1项随机试验）中收集了涉及788例ITP患者的数据。与对照组相比，根除成功的患者血小板计数增加有统计学显著差异[与未治疗患者相比，WMD为40.77×10⁹/L（95%CI，20.92 - 60.63）；与根除失败的患者相比为52.16（95%CI，34.26 - 70.05）；与幽门螺杆菌阴性患者相比为46.35（95%CI，27.79 - 64.91）]。此外，在荟萃回归模型中，幽门螺杆菌根除成功作为血小板计数增加的解释变量具有高度显著性。
我们的分析表明幽门螺杆菌根除与血小板计数增加之间存在紧密关联。然而，由于所分析研究设计的内在局限性，需要来自随机临床试验的进一步证据来证实根除治疗对血小板计数的影响。
