Liebman Howard A
Jane Anne Nohl Division of Hematology, University of Southern California-Keck School of Medicine, and Norris Cancer Hospital, Los Angeles, CA 90033, USA.
Hematology Am Soc Hematol Educ Program. 2008:212-8. doi: 10.1182/asheducation-2008.1.212.
Chronic immune thrombocytopenic purpura (CITP) is a diagnosis of exclusion that occurs either de novo or secondary to other underlying disorders. Chronic infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are now well-characterized causes of CITP. Between 6% and 15% of patients infected with HIV may develop thrombocytopenia. Patients with CITP with risk factors for HIV infection should be screened for the virus. Treatment of HIV-related CITP should be directed toward antiviral therapy with highly active antiretroviral therapy (HAART) regimens. Hepatitis C viral infection can also be associated with chronic thrombocytopenia, even in the absence of overt liver disease. While HCV-related thrombocytopenia is typically less severe than primary CITP, affected patients are at greater risk of major bleeding. Sustained suppression of HCV virus with interferon-ribavirin therapy can improve platelet counts. Screening for HCV infection should be considered in patients with ITP with risk factors for infection, from regions with high rates of infection or in patients with unexplained mild elevations of liver enzymes.
慢性免疫性血小板减少性紫癜（CITP）是一种排除性诊断，可原发或继发于其他潜在疾病。人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）的慢性感染是目前已明确的CITP病因。6%至15%的HIV感染患者可能会出现血小板减少。有HIV感染风险因素的CITP患者应进行病毒筛查。HIV相关CITP的治疗应采用高效抗逆转录病毒治疗（HAART）方案进行抗病毒治疗。丙型肝炎病毒感染也可能与慢性血小板减少有关，即使在没有明显肝病的情况下也是如此。虽然HCV相关的血小板减少通常不如原发性CITP严重，但受影响的患者发生大出血的风险更高。使用干扰素-利巴韦林疗法持续抑制HCV病毒可改善血小板计数。对于有感染风险因素、来自高感染率地区或有不明原因轻度肝酶升高的ITP患者，应考虑进行HCV感染筛查。
