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

Idiopathic thrombocytopenic purpura (ITP)is autoimmune disorder characterised by increased platelet destruction. Most of chronicity chronic idiopathic thrombocytopenic purpura(CITP) patients are audlts,it releated to the antibodies against platelets,but the definite pathogenesy is still not ascertain.We choose glucocorticoid treatment first of all,the remission rate is 70%. We can also use immunodepressant and gamma globulin to the paitents whose therapeutic efficacy is not good,but there are some nonresponsder and relapsing cases.So the investigation about etiopathogenisis and pathogenesy,adopting corresponding mean is the criticality of this diease .Helicobacter pylori has been clearly recognized as the main cause of digestive diease.In the near future,with the study of Helicobacter pylori,the relationship between Helicobacter pylori and idiopathic thrombocytopenic purpura has previously been attented. In 1998, Gasbarrini et al reported the releationship between chronic idiopathic thrombocytopenic purpura and Helicoba cter pylori, Helicobacter pylori eradication treatment can ameliorate the symptom and substantial increase the platelets in all H.pylori-positive adult with CITP. Subsequent studies of many abroad scholars aslo confirmed this point.On the other had,reports did not support the effectiveness of Helicobacter pylori erdaication in CITP.May be as follows:different strains of Helicobacter pylori, diversity etiological factors to chronic idiopathic thrombocytopenic purpura.So far ,the definite pathogenesy is still not ascertain.May be as follows:one hypothesis is that the response to H.pylori infection could influence the host's immunogenetic system,another possible is Molecular mimicry .To determine the effects of H.pylori eradication treatment on CITP.35 CITPpatients underwent 14C urea breath test and HP antigen test ,24 cases were diagnosed as H.pylori positive,11 cases were found to be H.pylori negative.H.pylori-positive patients consented to glucocorticoid with eradication treatment,four weeks after eradication treatment,the effect of eradication on H.pylori was assessed with 14C urea breath test.Only glucocorticoid to H.pylori-negative patients.Analysis the age , gender, clinical manifestation, m egakaryocyte account in bone marrow,platelet count befor treatment ,curative effect,changes of platelet count of two groups.All datas were expressed as mean±s,rate compare is expressed with X2 text,mean compare is expressed with the T-text and analysis of variance.The result suggest:①The incidence of H.pylori infection was 69%, H.pylori eradication rate was 79%.②H.pylori-positive patients were significantly older than H.pylori- negative patients, mean age 45.2±13.6yeas vs 30.7 group(with total effective rate 63%(P<0.05).③No difference between two group in sex(p>0.05)and clinical manifestation((p>0.05)④Symptoms and signs were dermatorrhagia, epistaxis,gingiva bleeding⑤The mean platelet c ounts befor treatment were 9.83±8.57×109/L vs 6.73±4.73×109/L(P>0.05).⑥Two groups showed increased number of bone marrow megakaryocytes, with dysmaturity,the mean megakaryocytes counts were 269.3±231.2 vs109.7±94.9个(p<0.05).⑦H.pylori-positive group:complete remission in 6 pations(25%),partial remission in 13 pations(42%),minor response in 5 pations (25%)and no response in 2 pations(2%),the total effective rate was 92%,sin gnificantly higher than that in H.pylori-negtive group(with total effective rate 63%)⑧Patients in whom H.pylori was eradicated had a significant increase in platelet counts from 9.6±8.6×109/L to110.5±63.9×109 /L( p<0.01),also higher than other groups(P<0.05).Patients in whom H.pylori was not eradicated had not significant increase in platelet counts from9.6±8.4×109 /L to 45.8±34.5×109 /L(P>0.05).H.pylori negative patients had a increase in platelet count from 6.7±4.7×10/L 9to 61.5±52.4×109/L( p=0.03).The incidence of H.pylori infection was higher than the incidence in the general populartion.The H.pylori-positive group had a higher mean age and incidence of hyperplastic bone marrow megakaryocytes.There was significant difference in the response to the CITP patients eradication treatment.To sum up,treatment of eradication H.pylori can raise platelet counts and curative effect.The treatment may be a new good option for a nonimmunosuppressive treatment for the CITP patients.