Helicobacters and Extragastric Diseases

For two decades, Helicobacter pylori has been considered as the culprit in many extragastric manifestations. However, for several of these supposed associations the hypothesis of an etiological role has not yet been fully investigated. This may be due to a series of factors linked to the epidemiological features of the studies and to the diseases investigated. This review attempts to highlight the main reported associations of H. pylori with extragastric manifestations during the last year. The most convincing data arise in the field of idiopathic thrombocytopenic purpura (ITP) and sideropenic anemia. Long-term follow-up studies have shown that 50% of subjects with ITP maintain a hematological response after H. pylori eradication. There is also growing evidence of the role of H. pylori in other diseases, including ischemic heart disease even though results are not conclusive.     

Helicobacter pylori infection and immune thrombocytopenic purpura: an update

Data are accumulating on the association between Helicobacter pylori infection and idiopathic thrombocytopenic purpura (ITP) and the significant increase in platelet count after bacterial eradication. The aim of this review was to consider the studies so far published on H. pylori infection and ITP in order to evaluate a possible correlation between these two conditions. A review of the literature showed that 278 out of the 482 ITP patients investigated (58%) were positive for H. pylori infection and that the bacterium was eradicated in 88% of cases. Eradication therapy was accompanied by a complete or partial platelet response in approximately half the cases. Overall, these data show that H. pylori eradication in patients with ITP is effective in increasing platelet count. However, because the studies so far published are few, are sometimes controversial and involve small series of patients, further studies on larger numbers of patients with longer follow-up are needed to confirm these preliminary findings.     

Thiazolidinediones increase the number of platelets in immune thrombocytopenic purpura mice via inhibition of phagocytic activity of the reticulo-endothelial system

Thiazolidinediones (TZDs) have broad spectrum of actions, including immunomodulating effects that are dependent or independent of the target nuclear receptor, peroxisome proliferator activated receptor-gamma (PPAR-gamma). In this study, we investigated the effect of TZDs on the platelet numbers in male immune thrombocytopenic purpura (ITP) model mice, (NZW x BXSB)F(1) (W/BF(1)) in vivo, and attempted to clarify the mechanism of action. Seven-day treatment with troglitazone increased platelet counts by 66% compared with those of controls. Within two weeks after the termination of the treatment period, the numbers of platelets were decreased to the level in controls. Pioglitazone showed only weak increasing effect on platelet counts in short-term experiment. However, long-term treatment with the drug resulted in a more pronounced up-regulation of platelets. We next assayed the platelet-associated antibodies (PAA) and the survival rate of antibody-sensitized mouse erythrocytes (Ab-mRBC) in W/BF1 mice. Pioglitazone slightly decreased the production of PAA and significantly elongated the survival period of Ab-mRBC in vivo. These drugs showed dose-dependent inhibitory effects on the cell proliferation and Fcgamma receptor (FcgammaR)-mediated phagocytic activity of macrophage-like cells in vitro. These results suggest that TZDs improve platelet counts in this mouse model mainly by suppressing systemic reticulo-endothelial phagocytic function.     

氯雷他定联合甲基强的松冲击治疗小儿过敏性紫癜的临床疗效

目的:观察氯雷他定联合甲基强的松冲击疗法治疗小儿过敏性紫癜的疗效,及其对患儿血清免疫学指标的影响。方法:将180例过敏性紫癜患儿随机分为对照组和观察组,每组各90例。所有患者均接受包括氯雷他定的基础治疗,观察组在此基础上加用甲基强的松冲击治疗。观察并比较两组的临床疗效、临床症状消失时间及治疗前后血清免疫学指标的变化情况。结果:观察组患儿治愈率和总有效率显著高于对照组,差异具有统计学意义(P0.05);观察组临床症状消失时间显著短于对照组,差异具有统计学意义(P0.05);治疗后,观察组患儿血清Ig A、C3、TNF-α及IL-10水平显著低于对照组,差异具有统计学意义(P0.05)。结论:氯雷他定联合甲基强的松龙能有效抑制炎症反应,调节免疫平衡,在小儿过敏性紫癜治疗中具有积极意义。     

孟鲁司特治疗儿童过敏性紫癜的临床疗效及对Toll样受体和IL-6, IL-8 表达的影响

目的:研究孟鲁司特治疗儿童过敏性紫癜的临床疗效及对Toll样受体(TLRs)和白介素-6(IL-6)、白介素-8(IL-8)表达的影响。方法:选取2011年2月到2015年2月我院收治的儿童过敏性紫癜患者150例,按照随机数字表法将患者分为研究组和对照组,每组75例,对照组给予常规治疗,研究组在对照组的基础上给予孟鲁司特,应用荧光定量PCR技术测量TLR2、TLR5和TLR9mRNA基因表达情况,应用酶联免疫吸附(EILSA)法测定患者血清中IL-6和IL-8水平,并比较两组临床疗效,皮疹消退、关节肿痛以及腹痛缓解时间。结果:研究组总有效率97.3%(73/75)显著高于对照组81.3%(61/75),两组比较差异具有统计学意义(P0.05);研究组皮疹消退、关节肿痛以及腹痛缓解时间均显著短于对照组,两组比较差异具有统计学意义(P0.05);两组治疗后TLR2、TLR5和TLR9m RNA表达水平显著低于治疗前,且研究组显著低于对照组,比较差异具有统计学意义(P0.05);两组治疗后IL-6和IL-8水平显著低于治疗前,且研究组显著低于对照组,比较差异具有统计学意义(P0.05)。结论:孟鲁司特治疗儿童过敏性紫癜具有较好的临床疗效,能显著降低TLRs、IL-6和IL-8水平。     

不同剂量雷公藤多苷联合复方丹参对过敏性紫癜性肾炎患者凝血功能及内皮细胞功能的影响

目的:考察不同剂量雷公藤多苷联合复方丹参对过敏性紫癜性肾炎(HSPN)患者凝血功能及内皮细胞功能的影响,并评价疗效。方法:选取我院2016年9月至2018年3月收治的72例HSPN患者,按照随机数字表法分成对照组(静脉滴注复方丹参注射液治疗)、低剂量组(1.0 mg/kg雷公藤多苷联合复方丹参注射液治疗)和高剂量组(1.5 mg/kg雷公藤多苷联合复方丹参注射液治疗),每组各24例,三组均治疗12周。分别于治疗前后检测三组患者凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)水平、活化部分凝血活酶时间(APPT)、血小板计数(PLT)、内皮细胞生长因子(VEGF)、内皮素-1(ET-1)水平及血流介导的血管扩张功能(FMD)。评价三组疗效,并观察治疗过程中出现的不良反应。结果:治疗后低剂量组、高剂量组TT、APPT较治疗前和对照组明显升高,FIB和PLT明显降低,且高剂量组较低剂量组变化更明显(P0.05),治疗后高剂量组PT高于治疗前、对照组和低剂量组(P0.05)。治疗后低剂量组、高剂量组VEGF及ET-1水平较治疗前降低,FMD值较治疗前升高,且高剂量组VEGF及ET-1水平低于对照组和低剂量组,FMD值高于对照组和低剂量组(P0.05)。高剂量组的有效率为95.83%(23/24),高于低剂量组的75.00%(18/24)和对照组的42.67%(10/24)。三组不良反应发生率无明显差异(P0.05)。结论:高剂量雷公藤多苷与复方丹参注射液合用较低剂量的合用可明显改善HSPN患者的凝血功能并恢复内皮细胞功能,疗效明显,安全性高。     

儿童ITP与婴儿ITP的临床特点差异以及疗效比较

目的：探讨儿童ITP与婴儿ITP的临床特点差异以及疗效比较。方法：对我院收治的301例儿童ITP根据年龄分为儿童组以及婴儿组,并对两组患儿的临床特点以及临床疗效进行比较。结果：两组患儿在性别、发病季节、临床表现以及严重程度均有明显的差异性（P〈0.05）;两组患儿在血红蛋白值、中性粒细胞计数、中性粒细胞百分比、CD3＋,CD8＋、以及淋巴细胞计数等比较均具有统计学差异性（P〈0.05）。两组患儿治疗有效率的比较,婴儿组患儿其治疗疗效明显优于儿童组（P〈0.05）。结论：婴儿ITP其临床表现多为男性多发,有明显的诱因,而且其具有症状轻、疗效好等特点。     

百令胶囊联合吗替麦考酚酯对过敏性紫癜性肾炎患儿肾功能、体液免疫功能及血清炎性因子的影响

摘要 目的：探讨百令胶囊联合吗替麦考酚酯对过敏性紫癜性肾炎（HSPN）患儿肾功能、体液免疫功能及血清炎性因子的影响。方法：选取2014年7月~2020年2月期间我院收治的80例HSPN患儿,按照随机数字表法分为对照组（n=40,吗替麦考酚酯治疗）和观察组（n=40,百令胶囊联合吗替麦考酚酯治疗）,对比两组疗效、肾功能[24 h尿蛋白定量（24 h Upro）、血肌酐（Scr）、尿素氮（BUN）]、体液免疫功能[免疫球蛋白(Ig)M、IgA、IgG]及血清炎性因子[γ-干扰素（IFN-γ）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）],记录两组治疗期间不良反应情况。结果：与对照组相比,观察组的总有效率更高（P<0.05）。两组不良反应发生率对比未见差异（P>0.05）。治疗3个月后,两组Scr、24 h Upro、BUN、IgM、IgA、IgG、IFN-γ、IL-6、TNF-α均较治疗前下降,且观察组较对照组低（P<0.05）。结论：百令胶囊联合吗替麦考酚酯治疗HSPN患儿疗效值得肯定,可有效改善患儿肾功能、体液免疫功能,减轻患儿炎性反应,且安全性较好。     

初步探讨过敏性紫癜兔模型的构建

目的通过构建过敏性紫癜动物模型,为该病治疗方法的评价和新药研发提供可能。方法通过对日本大耳白兔热性药物的喂饮、腹腔注射卵白蛋白和弗氏完全佐剂生理盐水的混合液,持续抗原刺激后,耳缘静脉和背部皮内注射卵白蛋白生理盐水,激发过敏反应来构建过敏性紫癜模型。实验过程中分别进行一般症状观察;平均每天饮食,饮水量、体温、血常规、尿常规、便潜血等测量;皮肤、肾脏等脏器病理检测,并与人类疾病患者症状、实验室检查及病理改变相比较。结果与对照组相比,模型组兔表现为皮肤瘀斑;每天进食减少、饮水增多(P<0.01),体温升高(P<0.05);血WBC增多(P<0.01),RBC减少(P<0.01),HGB、MCHC均降低(P<0.01),NEU、NEU%、EOS、EOS%均升高(P<0.01);67%尿蛋白、尿红细胞阳性,70%便潜血阳性;病理表现为皮下血管扩张充血、出血,真皮水肿,炎细胞浸润;肾小球局灶性慢性肾炎,囊腔蛋白渗出,血管扩张充血,系膜基质增多,系膜增厚,红细胞管型,炎细胞浸润等;关节腔淤血,结缔组织坏死,炎细胞浸润等;皮肤、肾IgA免疫球蛋白大量沉积等;胃黏膜出血,坏死脱落;小肠绒毛血管扩张充血,上皮细胞脱落;肺淤血,肥大细胞似有脱颗粒现象;肝灶性炎细胞浸润等,这些改变与人过敏性紫癜患者病变基本相似。结论大耳白兔通过热性药物的喂饮,连续抗原刺激,静脉和皮内抗原冲击后,其症状、病理改变和实验室检查结果与人类过敏性紫癜病变基本相似,有望构建良好的过敏性紫癜兔模型。