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2012, vol. 18, br. 3-4, str. 78-83
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Imuna trombocitopenija i Helycobacter pylori infekcija
Immune thrombocytopenia and Helicobacter pylori infection
aKlinički centar Kragujevac, Klinika za hematologiju, Srbija bKlinički centar Kragujevac, Klinika za internu medicinu, Srbija
e-adresa: sretenovicsnezana@yahoo.com
Sažetak
Uvod. Trombocitopenija se definiše kao smanjenje broja trombocita ispod 150x109/l1. Hronična imunološka trombocitopenična purpura (IT chr) je autoimuna bolest prouzrokovana destrukcijom trombocita obloženih antitrombocitnim autoantitelima u monocitno makrofagnom sistemu. H. pylori antitela mogu imati unakrsnu reakciju sa antigenima membrane trombocita. H. pylori je ubikvitarna gram-negativna bakterija koja je umešana u patogenezu čira na želucu i dvanaestopalačnom crevu, povezana je sa adenokarcinomom i MALT limfomom, a takođe i brojnim autoimunim bolestima među kojima je i idiopatska trombocitopenija. Cilj rada. Cilj rada je bio da se utvrdi: učestalost infekcije sa H. pylori među novodijagnostikovanim trombocitopenijama; korelacija endoskopski verifikovane lezije želudačne sluznice i H. pylori infekcije među našim ispitanicima; učinak eradikacione terapije na trombocitopeniju kod naših ispitanika. Metod. Učinjena je prospektivna analiza novootkrivenih bolesnika sa trombocitopenijom koji su prošli kroz jednu hematološku ambulantu u periodu od 01.03.2008. do 01.03.2009. a praćeni su do 01.02.2010. Analizirano je 50 bolesnika. Svi bolesnici su podvrgnuti fiberendoskopskom pregledu želuca uz politopske biopsije, urađen je ureaza test kojim je verifikovana infekcija sa H. pylori. Kod bolesnika su učinjeni analiza po polu i starosti kao i laboratorijske analize, vrednosti sedimentacije eritrocita, kompletne krvne slike, imunološke, virusološke, hemostazni parametri, analiza hepatograma i urina, anamneza i fizikalni pregled. Svim bolesnicima je urađena sternalna punkcija uz analizu mijelograma, koji je pokazao postojanje megakariocita. Statistički metodi obrade podataka su deskriptivni (mere centralne tendencije - aritmetička sredina) i analitička statistika - χ2 test i procentualna značajnost. Kriterijum za značajnost je p<0,05. Rezultati. Prosečna starost naših ispitanika je 52,4 godine; odnos polova 4:1 u korist žena. Nema korelacije između hemoragijskog sindroma i broja trombocita, nema razlike u učestalosti između blage, srednje teške i teške trombocitopenije. U 28/50 ispitanika postoji infekcija sa H. pylori. Patološke promene u želucu različitog stepena (erozije i ulkusi) dijagnostikovane su kod 22/28 pozitivna bolesnika. Sprovedena je eradikaciona terapija kod svih bolesnika i svi su dobro reagovali na prvu terapijsku liniju lečenja - kortikosteroidi. Od 50 ispitanika, kod 9 je verifikovana akutna trombocitopenija, kod 41 postoji hronična trombocitopenija. Samo jedan bolesnik je nakon sprovedene eradikacije H. pylori postigao normalan broj trombocita. Zaključak. Infekcija sa H. pylori je bila prisutna kod 56% ispitanika, što pokazuje neophodnost testiranja u ispitivanju trombocitopenije u našoj populaciji. Postoji visoka povezanost lezije sluznice želuca i infekcije sa Helicobacter pylori u naših ispitanika, χ2 test; p<0,05. Samo kod jednog bolesnika nakon eradikacione terapije Helicobacter pylori postignut je normalan broj trombocita u posmatranom periodu od 23 meseca, što ukazuje na multiple mehanizme nastanka trombocitopenije.
Abstract
Introduction: Thrombocytopenia is defined as number of thrombocytes les than 150x109/l. Chronic immune thrombocytopenic purpura (IT chr) is an autoimmune disease caused by destruction of thrombocytes encased with antithrombocyte autoantibodies in monocyte macrophage system. Anti H. pylori antibodies can cross-react with thrombocyte membrane antigens. H. pylori is widespread gram-negative bacterium, involved in pathogenesis of gastric and duodenal peptic ulcers, and associated with adenocarcinoma and MALT lymphoma, and various autoimmune diseases such as idiopathic thrombocytopenia. Objective: (1) Establish the frequency of H. pylori infection among newly diagnosed cases of thrombocytopenia. (2) Establish the correlation between lesions of gastric mucous membrane, confirmed by endoscopic evaluation, and H. pylori infection in our examinees. (3) Establish the effect of eradication therapy on thrombocytopenia in our examinees. Method: Prospective analysis of patients with thrombocytopenia who visited hematology outpatient department in period from 01.03.2008. to 02.03.2009, with follow-up until 01.02.2010. Research included 50 patients. Detailed medical history, physical examination, laboratory analyses (ESR, CBC, liver function tests, immune, viral, and haemostatic parameters and urine analysis), fiber gastric endoscopy with polytopic biopsy and Urease test evaluation of H. pylori infection, and bone marrow aspiration, which revealed the existence of megakaryocyte, were performed in all subjects. Statistical methods were descriptive methods (central tendencies measurement - arithmetic mean) analytic statistics - χ2 test and percentual significance. Criterion for significance is p<0.05. Results: The average age of the examinees is 52,4 years. The Male: female ratio is 1:4. There is no correlation between hemorrhagic syndrome and the number of platelets, also there is no difference in frequency of mild, moderate and severe thrombocytopenia. H. pylori infection was documented in 28 patients (out of 50). Various pathological changes in gaster (erosions and ulcers) were diagnosed in 22 out of 28 positive patients. Eradication treatment was conducted in all patients and they all responded on initial glucocorticoide treatment. 9 patients had acute thrombocytopenia, and 41 had Chronic thrombocytopenia. Platelet count was normalized in only 1 patient after H. pylori eradication therapy. Conclusion: H. pylori infection was present in 56% of patients which implies the necessity of H. pylori testing in thrombocytopenic patients. There is strong association between gastric mucosa lesions and H. pylori infection in our patients, χ2 test (p<0,05 ). Platelet count was normalized in only 1 patient after H. pylori eradication during 23 month long period of observation. That implies multiple mechanisms of thrombocytopenia.
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