Relative Study On Idiopathic Thrombocytopenic Purpura With HBV And MCV Infection

Objective:To study the relationship between the ITP and infection of HBV and CMV, and the cause of the ITP disease and curative effect of ITP patients with HBV or CMV infection ; to summarize the similarities and differences of clinic symptom,sign,laboratory experiments and treatments , and provide theoretical basis for prevention .diagnosis and treatment of the ITP disease with HBV and CMV infection .Methods:153 cases of ITP in-patients in our hospital (from January 2006 to July 2008 ) were studied. All patients were measured with serum remarks of HBV such as HBsAg ,HBsAb,HBcAb,HBeAg, HBeAb and the antigens of CMV pp65 of white blood cell in periperal vein .The positive results of HBsAg and pp65 determined that the ITP patients were infected by HBV and CMV respectively. 36 cases of HBsAg positive reaction and 31 cases of pp65 positive reaction in ITP patients were divided into HBV and CMV groups individualy. 35 ITP patients with negative reaction in both HBsAg and pp65 and 102 cases of health people with normal platelet count were randomly divided into negative group and normal control group individualy. The general clinical data of manifestation, laboratory test and therapy were analyzed with statistics method. Measuring data were indicated with±S , counting date were incated with frenquency . All results were analyzed with T test , analysis of variance ,chi-square test . Wilcoxon test and Fisher test .Results:1. Virus infective rates:the infective rates of HBV and CMV in ITP patients were 23.5% and 20.3% respectively , but those who in normal control with normal platelet count were 9.8% and 0% respectively . These were significantly difference between in infective group and normal control ( p<0.05 ) . 2 . Age: the average age of ITP patients with HBV or CMV infection and negative controls were 46.12+10.3 . 20.03+11.7 and 31.89+12.2 years, age variance between infective and negative group had significantly difference. 3. Sexual distinction :there were not significantly difference in ITP patients with HBV or CMV infection and negative group (P>0.05 ) . 4. Clinical manifestation: ITP patients with HBV or CMV infection were inclined to suffer from skin hemorrhage in comparison with negative group ( P<0.05) .Organ hemorrhage were not taken into account for insufficient cases . 5. Platelet count of the patients being hospitalized : the significantly deference between the ITP group with HBV or CMV infection and negation group(P>0.05) was not found. 6. Immunobiology indexes: immunobiology examinations included complement ( C3 . C4 ) , PAlgG and subgroup of T lymphocyte . These were not notable variance in ITP patients with negative or positive HBV and CMV infection in complement level,PAlgG and T lymphcyte subgroup (P>0.05 ) . By comparison with between ITP patients group and the normal group, the results showed significantly deference ( P<0.05 ), the ITP patients were lower level of complement, low proportoin of the CD4 T cells, and higher level of PAlgG and high proportion of CD8 T cells , and the T lymphocyte subgroup was disorder. 7.Bone marrow cytomorphologic examination:In the 36 ITP patients that have been infected HBV, there are two patients that bone marrow karyocyte proliferation have decreased. and there are one patient that hypersplenism. In the 31 ITP patients that have been infected CMV, there are one patient that bone marrow karyocyte proliferation have decreased. To analysis the two groups, the average of marrow megacaryocyte numbers are lower than negative control, there was a significance difference (P<0.05).Indicate that HBV or CMV infected groups of ITP patients are compensation of marrow productive reaction is inferior to negative control. The ration of infantilism megacaryocyte from the HBV or CMV infected groups is higher, and the granular megakaryocyte is lower, The difference is notable which compared with the negative control (P<0.05). Indicate that bone megakaryocytic from the ITP patients who infected HBV or CMV maturation lag more earlier.8.Treatment menthod and effect:after 3 days and 7 days with glucocorticoids therapy , HBV and CMV group showed slow- ascending platelet count and low treatmental curative effect in comparison with negative group (P<0.05 ) . The total efficiency of combined therapy,which glucocorticoids and ganciclovir in 20 ITP patients with CMV infection and gucocorticoids and IFN-αin 27 ITP patients with HBV infection, were 85.0% and 74.1% respectively .Conclusions:1. The infective rates of HBV and CMV in ITP patients were higher than those of normal control, HBV and CMV may be one of the viruses of the cause ITP disease. 2. The average age span had significantly deference in the negative group and HBV and CMV infection group. 3. Those ITP patients with HBV or CMV infection were inclined to occur skin hemorrhage. The ITP showed low level of platelet count, complement, the low proportion of CD4 T and higher level of PAlgG, high proportion of CD8 T, and the proportion of T lymphocyte subgroup was disorder, these results indicated both cellular and humoral immunity play important role in ITP . 4. The method of the combined therapy those ITP patients with HBV or CMV infection was efficient, glucocorticoids and ganciclovir was used in the patients of ITP with CMV infection and gucocorticoids and IFN-αwas used in ITP patients with HBV infection.