Rinaldi M, Perricone C, Ortega-Hernandez O-D, Perricone R, Shoenfeld Y
1Rheumatology, Allergology and Clinical Immunology, Department of Internal Medicine, University of Rome Tor Vergata, Italy.
Lupus. 2014 May;23(6):554-67. doi: 10.1177/0961203313499959.
Immune thrombocytopaenic purpura (ITP) is an autoimmune systemic disease detectable by the presence of low blood platelets count (<10(5)/µl) and the production of autoantibodies against glycoproteins expressed on the platelet surface. The clinical course is often acute, and life-threatening events may occur especially in children, with 52% of paediatric patients recovering either spontaneously or after treatment. A chronic ITP evolution is observed in 64% of adults, of whom 12% will develop an overlapping autoimmune disease. Several microbial agents such as CagA-positive Helicobacter pylori or Candida albicans and a number of viruses including CMV, EBV or HIV can potentially trigger ITP through molecular mimicry. Moreover, ITP improves after treatment of the underlying infection. Similarly, vaccines such as MMR may prompt ITP (IRR 5.48, 1.61-18.64, p < 0.006). Early recognition of the underlying microbial trigger and the removal of modifiable aetiopathogenetic factors should be integrated as a complementary treatment strategy in all patients who do not readily improve with standard ITP care.
免疫性血小板减少性紫癜（ITP）是一种自身免疫性全身性疾病，可通过低血小板计数（<10⁵/µl）以及针对血小板表面表达的糖蛋白产生自身抗体来检测。临床病程通常为急性，尤其在儿童中可能发生危及生命的事件，52%的儿科患者可自发恢复或经治疗后恢复。64%的成年人会出现慢性ITP进展，其中12%会发展为重叠性自身免疫性疾病。几种微生物因子，如CagA阳性幽门螺杆菌或白色念珠菌，以及多种病毒，包括巨细胞病毒（CMV）、EB病毒（EBV）或人类免疫缺陷病毒（HIV），都可能通过分子模拟引发ITP。此外，治疗潜在感染后ITP会有所改善。同样，如麻疹、腮腺炎、风疹联合疫苗（MMR）等疫苗可能引发ITP（发病率比值比5.48，1.61 - 18.64，p < 0.006）。对于所有经标准ITP治疗后效果不佳的患者，应将早期识别潜在的微生物触发因素并去除可改变的病因发病因素作为一种辅助治疗策略。
