The Clinical Correlative Study Between Helicobacter Pylori Infection And Adults

Objective:The purpose of this study was to investigate the prevalence of H. pylori infection in Chronic Immune thrombocytopenia in adult patients.To assess the H. pylori-CagA positive expression of H. pylori infection and the H. pylori-CagA negative expression in the CITP patients,We evaluated changes in platelet counts and the titre of H. pylori-CagA-IgG after successful eradication (Standard triple anti H. pylori treatment programs).As a control, peripheral platelet counts in patients with unsuccessful eradication therapy were also analysed. We investigated on a series of CITP patients with Helicobacter pylori infection and compared the effects of two groups of 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. We should explore more effective clinical treatment of such disorders and provide experimental basis for rational drugMethods:190patients were diagnosed as CITP in Sichuan Provincial People’s Hospital Sichuan Academy of Medical Sciences from February,2010to January,2012.14C urea breath tests (14C-UBT) were used to be diagnose H. pylori infection. A total of110cases were brought into this study. The median course of CITP was36months and the median age was45years. CITP patients with H. pylori infection who were classified into two groups based on H. pylori-CagA strains. Every group randomly divided into treatment and control group. All patients received7-14days standard triple therapy (Proton pump inhibitors, clarithromycin, amoxicillin) to eradicate H. pylori. If the treatment is failure,re-eradication was performed with triple therapy once again.Eradication was assessed after6-8weeks of finishing treatment by14C-UBT. The patients with H. pylori infection were had been a long follow-up (median follow-up of4months). We investigated the effect of eradication of H. pylori on the platelet count of CITP patients(consist of H. pylori-CagA positive strains and H. pylori-CagA negative strains patients). To evaluate the short-term effect before and after eradication therapy, We evaluated serum levels of H. pylori-CagA-IgG antibody titer and the platelet count. Result was expressed by mean±SD. Data were analyzed using the Student t test. P values<0.05were considered significant. X2test was used for comparison of the efficiency categorical data. n<40or T<5,Fisher exact test,A P value of less than0.05was considered significant.Results:A series of190CITP patients had been investigated almost for2years.110patients (79women,31men) were positive for H. pylori infection (57.89%) and there was no difference in platelet count between infected and uninfected patients [mean+SD (45.37±18.40)×109/L vs (46.27±18.50)×109/L, p=0.14]. Eradication of H.pylori was achieved in14out of23patients (60.87%)in H. pylori-CagA+CITP Treatment group. However, the control group urea breath test did not differ before and after treatment in those patients; Eradication of H. pylori was achieved in18out of32patients (56.25%)in H. pylori-CagA-CITP Treatment group,but the control group urea breath test did not differ before and after treatment in those patients.11of14patients of successful eradication showed an increased platelet count[(40.91±22.55)×109/L vs (71.24±37.01)×109/L, p=0.001]and decrease the titre of H.pylori-CagA-IgG. There was difference of the titre of H.pylori-CagA-IgG[(85.77±37.30)pg/mL vs(57.63±2.54)pg/mL,p=0.032<0.05]between responders and nonresponders in H. pylori-CagA positive CITP Treatment group.The platelet count did not differ before and after treatment in9patients in whom the bacterium was not eradicated. There was no statisticaly significant difference of the platelet count before and after treatment[(49.37±14.76)×109/L vs (52.35±14.31)×109/L,p=0.149>0.05] in18patients of successful eradication (56.25%) were in H. pylori-CagA negative CITP treatment groups. At the same time.the platelet count did not differ before and after treatment in14patients in whom the bacterium was not eradicated [(48.45±19.12)×10/L vs (51.76±14.85)×109/L,p=0.406>0.05].In a word, The reduction of anti-CagA antibody titer after eradication therapy was significantly greater than that of the Control group. The platelet count also increased than that of the Control group. The first response and duration of response to maintain in the patients in whom the eradication were achieved were median7days (3-23days) and46days (26-152days) respectively.Conclusion:Our study had shown the prevalence of H. pylori infection in CITP patients was57.89%. H. pylori-CagA positive expression46cases, the prevalence of H. pylori CagA positive infectionas41.82%(46/110).After H. pylori was eradicated in patients with the infection especially H. pylori-CagA positive strains, platelet count was increased. The studies aimed at investigating whether CagA-positive H. pylori strains may influence serological levels of high H. pylori-CagA-IgG,low-platelet count. Interestingly, the levels of all those markers were significantly changed in CagA-positive patients compared with negative after H. pylori was eradicated. We provide evidence that infections with CagA-positive(but not CagA-negative H. pylori strains) significantly decreased the platelet count in CITP. Bacterium eradication provides a new good option for a nonimmunosuppressive treatment in some CITP patients.CagA-positive H. pylori strains might be involved in CITP with high levels of H. pylori-CagA-IgG and bring about lower Platelet count. The study reports revealed excellent prognosis of the patients (CagA-positive) who responded to eradication but sample size is small. It remains to be confirmed by long-term multi-center controlled studies.