Tsumoto C, Tominaga K, Okazaki H, Tanigawa T, Yamagami H, Watanabe K, Nakao T, Koh K, Watanabe T, Fujiwara Y, Yamane T, Oshitani N, Hino M, Higuchi K, Arakawa T
Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Ann Hematol. 2009 Aug;88(8):789-93. doi: 10.1007/s00277-008-0667-5. Epub 2008 Dec 19.
Helicobacter pylori eradication is useful for improvement of a half of patients with idiopathic thrombocytopenic purpura (ITP), but its long-term therapeutic efficacy has not been elucidated. We investigated the long-term efficacy of H. pylori eradication in 30 cases with ITP that were included in our previous study regarding the association between H. pylori infection and ITP. Twenty-one cases were positive and nine cases were negative for H. pylori infection. H. pylori eradication therapy including secondary regimen was successful in 20 cases, half (responder) of whom showed ITP remission 1 month later. Nine responders could be followed up for a long time and did not show re-infection of H. pylori. Eight of nine needed no medication except for eradication therapy. Another case remained in remission for 1 year but thereafter needed a steroid therapy due to the recurrence. Eight nonresponders could be followed up for a long time. All these cases showed a bad clinical course even though they received the other post-treatments including steroid therapy. Three of nine H. pylori-negative cases underwent eradication therapy after obtaining the written informed consent, but none of them showed improvement. Of these three cases, two cases could be followed up. Only one case remained a remission although receiving corticosteroid as a post-treatment. Conditions of H. pylori-negative ITP cases were usually unstable for a long time. H. pylori eradication has a short-term efficacy for about half of H. pylori-positive ITP patients, and the responders to the eradication therapy may receive a long-term clinical benefit without other therapies.
根除幽门螺杆菌对半数特发性血小板减少性紫癜（ITP）患者的病情改善有益，但其长期治疗效果尚未阐明。我们对先前研究中纳入的30例ITP患者进行了幽门螺杆菌根除治疗的长期疗效调查，该研究涉及幽门螺杆菌感染与ITP之间的关联。幽门螺杆菌感染阳性21例，阴性9例。包括二线方案在内的幽门螺杆菌根除治疗在20例患者中取得成功，其中一半（反应者）在1个月后ITP病情缓解。9例反应者能够进行长期随访，未出现幽门螺杆菌再次感染。9例中有8例除根除治疗外无需其他药物治疗。另一例缓解持续了1年，但此后因复发需要使用类固醇治疗。8例无反应者能够进行长期随访。尽管接受了包括类固醇治疗在内的其他后续治疗，所有这些病例的临床病程均不佳。9例幽门螺杆菌阴性病例中有3例在获得书面知情同意后接受了根除治疗，但均未见改善。这3例中有2例能够进行随访。仅1例在接受后续皮质类固醇治疗后仍处于缓解状态。幽门螺杆菌阴性ITP病例的病情通常长期不稳定。幽门螺杆菌根除治疗对约半数幽门螺杆菌阳性ITP患者具有短期疗效，根除治疗的反应者可能无需其他治疗即可获得长期临床益处。
