Proof of an association between Helicobacter pylori and idiopathic thrombocytopenic purpura in Latin America

BACKGROUND: Association between Helicobacter pylori and idiopathic thrombocytopenic purpura (ITP) has been found in Japan and in some European countries. It has also been shown that eradication of H. pylori can increase platelet counts in patients with ITP. The aims of this study were to determine the prevalence of H. pylori infection in patients with ITP in Colombia, and the effect of bacterial eradication on their platelet counts. MATERIALS AND METHODS: Between December 1998 and April 2006, a total of 32 patients diagnosed with ITP were included in the study. Controls were age and sex matched. RESULTS: H. pylori infection in patients with ITP was significantly higher (p = .00006) than in control individuals (90.6% and 43.8%, respectively), as determined by (13)C-urea breath test. A significant association between H. pylori infection and ITP was found (p < .0003), with an odds ratio (OR) of 13.15 (95%CI: 3.24-53.29). Multivariate analysis for the association between H. pylori and ITP showed an OR of 20.44 (95%CI: 3.88-107.49) for women and 19.28 (95%CI: 2.03-183.42) for individuals over 50 years. All 29 H. pylori-positive patients with ITP received eradication treatment. After a median follow up of 12.2 months, 80.8% had a recovery in platelet counts. CONCLUSIONS: According to these results and others from different countries where H. pylori infection rates are high, patients with ITP should be initially tested for H. pylori status, and if present, infection should be eradicated before initiating a drastic conventional ITP treatment. An algorithm for the study and management of patients with ITP in the post-Helicobacter era is presented.     

培菲康在儿童腹型过敏性紫癜中的应用

目的探讨活菌剂培菲康在腹型过敏性紫癜(HSP)治疗中的辅助作用。方法选择2004年8月至2006年1月,腹型HSP的住院患儿325例,其中男187例,女138例,年龄3～14岁,病程1～16 d。随机分为培菲康治疗组173例,对照组152例。2组病例在性别、年龄、病程长短及临床表现方面差异均无统计学意义。所有患儿入院后均予免动物蛋白流食或禁食。对照组给予维生素C、能量合剂、西米替丁及糖皮质激素等综合治疗,合并感染者给予抗生素、消化道出血的给予止血敏、维生素K1等。观察组在此基础上加用培菲康1袋,3次/d。用药1周后进行疗效判定。结果 2组患者治疗效果比较:总有效率培菲康治疗组为96.5%,对照组为91.4%,P<0.05。2组患者消化道症状消失时间比较:培菲康治疗组小于对照组,P<0.05。结论活菌剂培菲康对腹型HSP的治疗显示出了一定的疗效,临床证明培菲康可保护胃黏膜,防止胃肠道出血,减轻腹痛症状,从而可缩短病程,临床值得应用。其作用机制目前尚不明确,可能与其发挥免疫系统的调节作用有关。     

原发性血小板减少性紫癜合并侵袭性真菌感染2例报告附文献复习

目的 报道2例难治性原发性血小板减少性紫癜（ITP）患者用大剂量激素和（或）免疫抑制剂后发生侵袭性真菌感染（IFI）,其治疗经过及相关文献复习。方法 2例难治性ITP患者用大剂量激素和（或）免疫抑制剂后发生IFI,用大扶康、两性霉素B,降颅压,辅助呼吸等治疗。结果 例1发生隐球菌脑膜脑炎、例2出现肺曲酶菌感染,均经抗真菌治疗无效死亡。结论 长期应用激素及免疫抑制剂是难治性ITP患者发生IFI的危险因素,治疗困难,确诊后用药应足量、足疗程。     

Extragastric manifestations of Helicobacter pylori infection--other Helicobacter species

Recent studies have indicated a strong link between Helicobacter pylori and idiopathic thrombocytopenic purpura and iron deficiency anemia. Interesting results have also been obtained for ischemic heart disease, though most putative associations between H. pylori infection and extragastric disease remain speculative. With regard to other Helicobacter species, Helicobacter felis has been shown to play a role in gastric carcinogenesis in mouse models. An increased susceptibility to cholesterol gallstone formation has been described in animals fed a lithogenic diet and infected with Helicobacter bilis, or co-infected with Helicobacter hepaticus and Helicobacter rodentium. Finally, enterohepatic Helicobacter species have also been exploited to better understand inflammatory bowel disease.     

Epistatic interactions in idiopathic pulmonary arterial hypertension

BACKGROUND:

Idiopathic pulmonary arterial hypertension (IPAH) is a poorly understood complex disorder, which results in progressive remodeling of the pulmonary artery that ultimately leads to right ventricular failure. A two-hit hypothesis has been implicated in pathogenesis of IPAH, according to which the vascular abnormalities characteristic of PAH are triggered by the accumulation of genetic and/or environmental insults in an already existing genetic background. The multifactor dimensionality reduction (MDR) analysis is a statistical method used to identify gene–gene interaction or epistasis and gene–environment interactions that are associated with a particular disease. The MDR method collapses high-dimensional genetic data into a single dimension, thus permitting interactions to be detected in relatively small sample sizes.

AIM:

To identify and characterize polymorphisms/genes that increases the susceptibility to IPAH using MDR analysis.

MATERIALS AND METHODS:

A total of 77 IPAH patients and 100 controls were genotyped for eight polymorphisms of five genes (5HTT, EDN1, NOS3, ALK-1, and PPAR-γ2). MDR method was adopted to determine gene–gene interactions that increase the risk of IPAH.

RESULTS:

With MDR method, the single-locus model of 5HTT (L/S) polymorphism and the combination of 5HTT(L/S), EDN1(K198N), and NOS3(G894T) polymorphisms in the three-locus model were attributed to be the best models for predicting susceptibility to IPAH, with a P value of 0.05.

CONCLUSION:

MDR method can be useful in understanding the role of epistatic and gene–environmental interactions in pathogenesis of IPAH.     

波生坦治疗特发性肺动脉高压的疗效与安全性观察

目的:探讨波生坦治疗特发性肺动脉高压(IPAH)的疗效与安全性。方法:16例IPAH患者予波生坦口服治疗20周,比较治疗前后患者心功能、6分钟步行距离(6MWD)、肺动脉压力以及血常规、肝肾功能变化。结果:患者心功能由治疗前Ⅲ级13例、Ⅳ级3例变为Ⅱ级14例、Ⅲ级2例。6MWD较治疗前明显延长(P<0.01),肺动脉收缩压、肺动脉平均压及肺动脉舒张压均较治疗前显著降低(P<0.01),患者血常规、肝肾功能较治疗前无明显变化。结论:口服波生坦治疗IPAH可明显改善患者的临床症状与血流动力学指标,安全性好。     

新疆地区维吾尔族和汉族人群CaSR基因多态性与草酸钙肾结石关系的研究

目的:探讨新疆地区维吾尔族和汉族草酸钙结石与钙敏感受体(calcium sensitive receptor,Ca SR)基因多态性之间的关系。方法:选择398例临床确诊泌尿系草酸钙结石患者(200例维吾尔族,198例汉族)和399例正常对照者(200例维吾尔族,199例汉族),应用Sna Pshot方法对Ca SR基因两位点(rs1042636,rs1801726)的基因型及等位基因频率进行检测,并分析其与草酸钙结石发病的相关性以及对血钙、24 h尿钙水平的影响。结果:各组2个位点的基因型分布均符合Hardy-Weinberg平衡。汉族结石组与汉族对照组及维吾尔族结石族与维吾尔族对照组rs1042636、rs1801726位点基因型分布及基因频率差异均无统计学意义(P0.05)。维吾尔和汉族rs1042636基因型及等位基因频率比较差异有统计学意义(P0.05),且维吾尔族人群携带rs1042636等位基因A的风险高于汉族人群(病例组中OR值=2.145,%95CI=[1.602~2.866],P0.01;对照组中OR值=1.773,%95CI=[1.332~2.359],P0.01),其中维/汉病例组中等位基因频率分别为A=278(69.5%)/204(51.5%),G=122(30.5%)/192(48.5%);维/汉对照组中等位基因频率分别为A=264(66.0%)/208(52.3%),G=136(34.0%)/190(47.7%)。而病例组和对照组rs1801726基因型频率差异无统计学意义(P0.05);汉族病例组、对照组发现GG+AG基因型较AA基因型有较高的尿钙水平(病例组:P=0.007和对照组:P=0.006),维吾尔族人群该位点与两项指标无相关性。结论:Ca SR基因2个基因位点rs1042636、rs1801726可能不是新疆地区维吾尔族和汉族草酸钙结石发病的危险因子,两族rs1042636基因多态性分布存在差异,rs1042636位点基因多态性能影响汉族人群尿钙排泄,可能汉族调节钙排泄的遗传因素之一。     

特发性室性早搏与心率变异性的相关性分析

目的:探讨特发性室性早搏(IPVCs)与心率变异性(HRV)的相关性。方法:回顾性分析2016年2月～2018年2月我院心内科收治的150例IPVCs患者的临床资料,根据负荷量、心功能,将IPVCs患者分别分为低负荷组(1%～10%,n=51)、中负荷组(10%～20%,n=65)、高负荷组(20%,n=34)及LVEF50%组(n=106)、LVEF≤50%组(n=44)。另选取同期健康者50例作为对照组。检测和比较各组HRV相关指标变化,并分析IPVCs与HRV的相关性。结果:高负荷组RMMSD、PNN50明显低于对照组、低负荷组和中负荷组,中负荷组和高负荷组LF、HF明显低于对照组、低负荷组(P0.05),高负荷组LF、HF均明显低于中负荷组(P0.05)。LVEF≤50%组RMMSD、PNN50、LF、HF较对照组、LVEF50%组明显降低(P0.05)。IPVCs负荷与LVEDD、LVESD呈显著正相关,与LVEF呈显著负相关(P0.05)。IPVCs负荷与RMMSD、PNN50、LF、HF呈显著负相关(P0.05)。结论:IPVCs的发生与自主神经功能调节失衡有关,迷走神经张力减弱具有重要作用,从而诱发HRV异常。     

Circulating peripheral blood fibrocytes in human fibrotic interstitial lung disease

Fibrotic interstitial lung diseases are illnesses of unknown cause characterized by progressive decline in lung function. Fibrocytes are bone marrow-derived, circulating progenitor cells capable of differentiating into diverse mesenchymal cell types. Prior work has shown fibrocytes to traffic to the lung via the CXCL12-CXCR4 chemokine axis in an animal model of pulmonary fibrosis. We therefore assessed the relevance of fibrocytes in patients with fibrotic interstitial lung disease. We found enhanced expression of CXCL12 in both the lungs and plasma of patients with lung fibrosis. CXCL12 levels were associated with an order of magnitude higher number of circulating fibrocytes in the peripheral blood of these patients. Most of the circulating fibrocytes in patients with interstitial lung diseases were negative for the myofibroblast marker alpha-smooth muscle actin, suggesting a relatively undifferentiated phenotype. Taken together, these data suggest that fibrocytes are involved in the pathogenesis of human lung fibrosis.