Veres Gábor, Karóczkai István, Bodánszky Hedvig, Marosi Anikó, Magyarossi Edina, Dezsofi Antal, Arató András
Semmelweis Egyetem, Altalános Orvostudományi Kar, I. Gyermekgyógyászati Klinika, Budapest.
Orv Hetil. 2009 Apr 26;150(17):801-4. doi: 10.1556/OH.2009.28581.
Helicobacter pylori infection has been associated with immune thrombocytopenic purpura in adults, however, the few studies concerning this issue showed conflicting results in the paediatric field. Therefore, authors prospectively investigated the incidence of Helicobacter pylori infection and the effect of Helicobacter pylori eradication on platelet count recovery in children with immune thrombocytopenic purpura.
The study included 27 children with immune thrombocytopenic purpura (13 boys and 14 girls) with a median age of 8.2 years (range, 18 months-18 years). 38 healthy children (controls) were also enrolled (20 boys, 18 girls, median age, 9.6 years, range, 4-18 years). Helicobacter pylori infection was diagnosed using 13 C urea breath test. Eradication was assessed at 6 weeks following the end of the treatment by 13 C urea breath.
2 children out of 27 patients with immune thrombocytopenic purpura proved to be positive for Helicobacter pylori infection (7.7%) and were treated with combination therapy. Controls showed similar rate of Helicobacter pylori infection (3/38, 7.9%) in comparison to those with immune thrombocytopenic purpura. In the follow-up period (mean, 10 months, range, 6-14 months) platelets did not show any improvement in infected children following the eradication treatment and were identical to those of the uninfected patients. Eradication was successful in the 2 Helicobacter pylori infected patients with immune thrombocytopenic purpura.
The results do not suggest a pathogenetic role of Helicobacter pylori infection in the etiology of immune thrombocytopenic purpura. Screening of Helicobacter pylori infection among paediatric patients with immune thrombocytopenic purpura is not recommended.
幽门螺杆菌感染与成人免疫性血小板减少性紫癜有关,然而,关于这个问题的少数研究在儿科领域显示出相互矛盾的结果。因此,作者前瞻性地调查了免疫性血小板减少性紫癜患儿幽门螺杆菌感染的发生率以及根除幽门螺杆菌对血小板计数恢复的影响。
该研究纳入了27例免疫性血小板减少性紫癜患儿(13例男孩和14例女孩),中位年龄为8.2岁(范围为18个月至18岁)。还纳入了38名健康儿童(对照组)(20例男孩,18例女孩,中位年龄9.6岁,范围为4至18岁)。采用¹³C尿素呼气试验诊断幽门螺杆菌感染。治疗结束6周后通过¹³C尿素呼气评估根除情况。
27例免疫性血小板减少性紫癜患者中有2例幽门螺杆菌感染呈阳性(7.7%),并接受了联合治疗。与免疫性血小板减少性紫癜患者相比,对照组幽门螺杆菌感染率相似(3/38,7.9%)。在随访期(平均10个月,范围为6至14个月),根除治疗后感染儿童的血小板没有任何改善,与未感染患者的血小板相同。2例感染幽门螺杆菌的免疫性血小板减少性紫癜患者根除成功。
结果不提示幽门螺杆菌感染在免疫性血小板减少性紫癜病因学中具有致病作用。不建议对免疫性血小板减少性紫癜患儿进行幽门螺杆菌感染筛查。