Maghbool Maryam, Maghbool Masood, Shahriari Mehdi, Karimi Mehran
Pathology Department, Shiraz University of Medical Science, Shiraz, Iran.
Pediatr Rep. 2009 Jun 8;1(1):e2. doi: 10.4081/pr.2009.e2.
Idiopathic thrombocytopenic purpura (ITP) is an acute self-limited bleeding disorder that can progress to chronic form in 10-15% of the cases. Helicobacter pylori (H. pylori) infection is a possible cause of chronic ITP. We studied 30 children with resistant chronic ITP for H. pylori infection based on the detection of H. pylori fecal antigen. This retrospective study was based on data obtained from medical records of 30 children aged between five and 17 years (median age at ITP diagnosis was ten years). A specially-designed data sheet was used to record information on age, sex, duration of disease, family history of bleeding disorders, previous treatments and median platelet count. In patients with H. pylori infection, antimicrobial treatment consisted of amoxicillin, metronidazol and omeprazol. Response was assessed every month for one year and defined as complete (platelet count >150×10(9)/L) or partial (platelet count between 50 and 150×10(9)/L). We detected H. pylori infection in 5 patients. In 4 of them increased platelet count was seen during one year of follow-up and in one patient the platelet count was acceptable during six months. Although the pathological mechanism of H. pylori-induced thrombocytopenia was unclear in our patient sample, the assessment of H. pylori infection and use of eradication therapy should be attempted in chronic and resistant ITP patients.
特发性血小板减少性紫癜（ITP）是一种急性自限性出血性疾病，10%-15%的病例可进展为慢性形式。幽门螺杆菌（H. pylori）感染是慢性ITP的一个可能病因。我们基于对幽门螺杆菌粪便抗原的检测，研究了30例难治性慢性ITP患儿的幽门螺杆菌感染情况。这项回顾性研究基于从30例年龄在5至17岁（ITP诊断时的中位年龄为10岁）儿童的医疗记录中获取的数据。使用专门设计的数据表记录年龄、性别、病程、出血性疾病家族史、既往治疗情况及血小板计数中位数等信息。对于幽门螺杆菌感染患者，抗菌治疗包括阿莫西林、甲硝唑和奥美拉唑。在一年时间里每月评估治疗反应，定义为完全缓解（血小板计数>150×10⁹/L）或部分缓解（血小板计数在50至150×10⁹/L之间）。我们检测到5例患者存在幽门螺杆菌感染。其中4例在一年的随访期间血小板计数升高，1例患者在6个月内血小板计数可接受。尽管在我们的患者样本中幽门螺杆菌诱导血小板减少的病理机制尚不清楚，但对于慢性难治性ITP患者，应尝试评估幽门螺杆菌感染并使用根除疗法。
