Analysis Of The Relationship Between Helicobacter Pylori Infection And Chronic Idiopathic Thrombocytopenic Purpura

Objective Idiopathic thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by a low platelet count and mucocutaneous bleeding. The causes are destruction of platelets in the reticuloendothelial system mediated by platelet-bound autoantibodies and reduction of platelets produced from megakaryocytes. ITP can be classified as acute ITP and chronic ITP (CITP). To verify the prevalence of Helicobacter pylori (H. pylori) infection and the effects of eradicating in the patients with CITP, we investigated on a series of CITP patients with Helicobacter pylori infection and compared the effects of H. pylori eradication therapy to only prednisone treatment (or the others) in the CITP patients. We analyzed if there is significant differences in the evolution of CITP depending on the H. pylori infection status and on the response to the eradication treatment. Material and Methods 34 patients, who were diagnosed as CITP in West China Hospital of Sichuan University from October, 2003 to March, 2004, were brought into this study and were classified into two groups based on H. pylori stool antigen test (HpSA) and serological H. pylori -IgG antibody test. The patients who had positive result from the two tests of above were treatedwith H. pylori eradication and had been a long follow-up. The content of follow-up included the platelet counU HpSA, and platelet antibody. Result was expressed as mean±SD. X2 test was used for comparison of categorical data. A P value of less than 0.05 was considered significant. Results A series of 34 CITP patients had been investigated for 5 months. 20 patients (14 women, 6 men) were positive for H. pylori infection (58.82%) and received eradication treatment. There was no difference in platelet countbetween infected and uninfected patients (^±SD 40.7514><109/L[SD 32.1500]vs 23.2695xl09/L[SD 15.5151], P=0.076>0.05). Eradication of H. pylori was achieved in 11 out of 20 patients (55%). Patients in whom H. pylori waseradicated had a significant increase in platelet count (^±SD 17.0008 xlO9/L[SD 5.1259] vs 26.3841 xlO9/L[SD 7.9551], P=0.011<0.05) and decrease in platelet antibody . The platelet count did not differ before and after treatmentin those patients in whom the bacterium was not eradicated ( x ^D26.1011*109/L[SD 13.9292] vs 51.8456*109/L[SD 39.2778], P=0.138>0.05) . The first response and duration of response to maintain in the patients in whom the eradication were achieved were median 6 days (3~28days) and 75 days (17-125 days) respectively.Conclusion Our study had shown the prevalence of H. pylori infection in CITP patients was 58.82%. The bacterium eradication was obtained in 11 of 20 H. pylori-positive patients (55%). 1 (5%) of 20 patients who had been treated acquaired excellent resules, 4 patients (20%) achieved the good effectiveness and 11 patients (55%) showed the improvement, while 4 patients (20%) showed the invalid results. 9 (56.25%) of 16 valid patients(including excellent results good effectiveness and improvement) had been eradicated, while 7 (43.75%) had been failure to eradicate. 2 (50%) of 4 invalid patients achieved the eradication, and the same result in the patients were not achieved . There was significant difference in the response to the CITP patients eradication treatment. This suggested that the treatment may be a new good option for a nonimmunosuppressive treatment for the CITP patients.