乙型肝炎病毒和巨细胞病毒感染与特发性血小板减少性紫癜临床相关性分析与研究
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摘要
目的:探讨HBV、CMV感染与ITP的关系,HBV、CMV感染所致ITP的发生机制,及其对ITP患者治疗与疗效的影响,总结HBV、CMV感染的ITP患者与阴性对照组ITP患者临床症状、体症、实验室检查及治疗方面的异同点,为预防、诊断及治疗HBV、CMV感染的ITP提供理论依据。
方法:本文调查2006年1月-2008年7月在我院诊断为ITP并住院治疗的153例患者。153例在治疗前均行HBV血清标志物HBsAg、HBsAb、HBcAb、HBeAg、HBeAb检测,HBsAg阳性者为ITP患者感染了HBV;同时行外周血白细胞CMV PP65抗原检测,PP65阳性者为ITP感染了CMV。共有36例ITP患者HBsAg为阳性,31例ITP患者PP65阳性。将36例HBsAg阳性的ITP患者列为HBV感染组,31例PP65阳性的ITP患者列为CMV感染组,随机抽取同期住院的HBsAg、PP65均为阴性的35例ITP患者列为阴性对照组,并随机抽取血小板正常的健康体检者102例列为正常对照组。采用统计学方法对四个组的一般资料与临床表现进行了统计与分析,采用免疫学与细胞形态学方法对四个组的病毒感染情况、免疫学指标及骨髓细胞形态学进行了检测,采用不同的治疗方案对不同的ITP患者进行了治疗,并观察比较疗效。计量资料采用均数±标准差表示,两组间及组内均数的差异采用t检验,或Wilcoxon秩和检验进行分析,定性资料采用频数(率)表示,组间差异采用X2检验或Fisher精确概率检验。
结果:1.病毒感染情况:153例ITP患者HBV感染率23.5%,CMV感染率20.3%,血小板正常的健康体检者HBV感染率9.8%,CMV感染率0%。ITP组与正常对照组相比有显著差异(P<0.05)。2.年龄状况:HBV感染组平均年龄46.12±10.3,CMV感染组平均年龄20.03±11.7,阴性对照组平均年龄31.89±12.2,感染组与阴性对照组比较有显著差异(P<0.05)。3.性别状况:ITP多见于女性,约为男性的2倍,但两个感染组ITP与阴性对照组ITP在性别上无显著性差异(P>0.05)。4.临床症状:HBV、CMV感染组ITP更易发生皮肤出血,与阴性对照组比较有显著性差异(P<0.05)。鼻衄及齿龈出血方面比较无显著性差异(P>0.05)。至于脏器出血,因病例数较少,未行统计学比较。5、入院时血小板数:HBV、CMV感染组ITP入院时血小板数与阴性对照组相比无显著性差异(P>0.05)。6、免疫学指标:免疫学指标检测包括补体(C3、C4)、PAIgG及T淋巴细胞亚群的检测。HBV、CMV感染组ITP补体水平、PAIgG及T淋巴细胞亚群与阴性对照组ITP相比较无显著性差异(P>0.05)。但ITP与正常对照组相比这三项指标有显著性差异(P<0.05), ITP患者补体水平下降,PAIgG明显增高,T淋巴细胞亚群比例失调,CD4百分比减低,CD8百分比增高。7、骨髓细胞学检查:36例感染了HBV的ITP出现了2例骨髓有核细胞增生减低,1例脾功能亢进骨髓象,31例感染了CMV的ITP出现了1例骨髓有核细胞增生减低。对三组ITP骨髓巨核细胞分析比较,HBV、CMV感染组ITP骨髓巨核细胞均值都少于阴性对照组,二者之间有显著性差异(P<0.05),提示HBV、CMV感染组ITP骨髓巨核细胞代偿增生性反应不及阴性对照组,HBV、CMV感染组幼稚型巨核细胞比例高,颗粒型巨核细胞比例少,与阴性对照组相比有显著性差异(P<0.05),提示HBV、CMV感染的ITP骨髓巨核细胞成熟停滞阶段更早。8、治疗方案与治疗效果:三组ITP首先均按常规方案行糖皮质激素治疗,于治疗第三天与第7天检测血小板并进行分析,HBV、CMV感染组血小板上升慢,治疗总有效率低,与阴性对照组相比有显著性差异(P<0.05)。糖皮质激素治疗效果较差的20例伴CMV感染的ITP,用糖皮质激素治疗的同时伍用更昔洛韦,27例伴HBV感染的ITP,同时伍用IFN-α,可明显提高治疗效果,总有效率达85.0%和74.1%。
结论:1、153例ITP患者HBV感染率23.5%,CMV感染率20.3%,102例血小板正常的健康体检者其HBV感染率9.8%,CMV感染率0%。ITP患者与正常健康体检者之间两种病毒感染率存在显著性差异(P<0.05),因此HBV、CMV感染可能是诱发ITP的病毒之一。
2、HBV、CMV感染组ITP患者更易发生皮肤出血;HBV、CMV感染的ITP患者骨髓巨核细胞代偿增生性反应不及阴性对照组,且巨核细胞成熟停滞阶段更早,少数可导致骨髓抑制。
3、ITP组补体水平下降,PAIgG明显增高,外周血CD4百分比减低,CD8百分比增高,提示了ITP患者不仅有体液免疫紊乱,同时存在细胞免疫异常。
4、感染了HBV、CMV的ITP患者单纯用糖皮质激素治疗疗效较差,CMV感染的ITP患者若伍用更昔洛韦,HBV感染的ITP患者若伍用IFN-α,可缩短病程,提高治疗效果。
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.
方法:本文调查2006年1月-2008年7月在我院诊断为ITP并住院治疗的153例患者。153例在治疗前均行HBV血清标志物HBsAg、HBsAb、HBcAb、HBeAg、HBeAb检测,HBsAg阳性者为ITP患者感染了HBV;同时行外周血白细胞CMV PP65抗原检测,PP65阳性者为ITP感染了CMV。共有36例ITP患者HBsAg为阳性,31例ITP患者PP65阳性。将36例HBsAg阳性的ITP患者列为HBV感染组,31例PP65阳性的ITP患者列为CMV感染组,随机抽取同期住院的HBsAg、PP65均为阴性的35例ITP患者列为阴性对照组,并随机抽取血小板正常的健康体检者102例列为正常对照组。采用统计学方法对四个组的一般资料与临床表现进行了统计与分析,采用免疫学与细胞形态学方法对四个组的病毒感染情况、免疫学指标及骨髓细胞形态学进行了检测,采用不同的治疗方案对不同的ITP患者进行了治疗,并观察比较疗效。计量资料采用均数±标准差表示,两组间及组内均数的差异采用t检验,或Wilcoxon秩和检验进行分析,定性资料采用频数(率)表示,组间差异采用X2检验或Fisher精确概率检验。
结果:1.病毒感染情况:153例ITP患者HBV感染率23.5%,CMV感染率20.3%,血小板正常的健康体检者HBV感染率9.8%,CMV感染率0%。ITP组与正常对照组相比有显著差异(P<0.05)。2.年龄状况:HBV感染组平均年龄46.12±10.3,CMV感染组平均年龄20.03±11.7,阴性对照组平均年龄31.89±12.2,感染组与阴性对照组比较有显著差异(P<0.05)。3.性别状况:ITP多见于女性,约为男性的2倍,但两个感染组ITP与阴性对照组ITP在性别上无显著性差异(P>0.05)。4.临床症状:HBV、CMV感染组ITP更易发生皮肤出血,与阴性对照组比较有显著性差异(P<0.05)。鼻衄及齿龈出血方面比较无显著性差异(P>0.05)。至于脏器出血,因病例数较少,未行统计学比较。5、入院时血小板数:HBV、CMV感染组ITP入院时血小板数与阴性对照组相比无显著性差异(P>0.05)。6、免疫学指标:免疫学指标检测包括补体(C3、C4)、PAIgG及T淋巴细胞亚群的检测。HBV、CMV感染组ITP补体水平、PAIgG及T淋巴细胞亚群与阴性对照组ITP相比较无显著性差异(P>0.05)。但ITP与正常对照组相比这三项指标有显著性差异(P<0.05), ITP患者补体水平下降,PAIgG明显增高,T淋巴细胞亚群比例失调,CD4百分比减低,CD8百分比增高。7、骨髓细胞学检查:36例感染了HBV的ITP出现了2例骨髓有核细胞增生减低,1例脾功能亢进骨髓象,31例感染了CMV的ITP出现了1例骨髓有核细胞增生减低。对三组ITP骨髓巨核细胞分析比较,HBV、CMV感染组ITP骨髓巨核细胞均值都少于阴性对照组,二者之间有显著性差异(P<0.05),提示HBV、CMV感染组ITP骨髓巨核细胞代偿增生性反应不及阴性对照组,HBV、CMV感染组幼稚型巨核细胞比例高,颗粒型巨核细胞比例少,与阴性对照组相比有显著性差异(P<0.05),提示HBV、CMV感染的ITP骨髓巨核细胞成熟停滞阶段更早。8、治疗方案与治疗效果:三组ITP首先均按常规方案行糖皮质激素治疗,于治疗第三天与第7天检测血小板并进行分析,HBV、CMV感染组血小板上升慢,治疗总有效率低,与阴性对照组相比有显著性差异(P<0.05)。糖皮质激素治疗效果较差的20例伴CMV感染的ITP,用糖皮质激素治疗的同时伍用更昔洛韦,27例伴HBV感染的ITP,同时伍用IFN-α,可明显提高治疗效果,总有效率达85.0%和74.1%。
结论:1、153例ITP患者HBV感染率23.5%,CMV感染率20.3%,102例血小板正常的健康体检者其HBV感染率9.8%,CMV感染率0%。ITP患者与正常健康体检者之间两种病毒感染率存在显著性差异(P<0.05),因此HBV、CMV感染可能是诱发ITP的病毒之一。
2、HBV、CMV感染组ITP患者更易发生皮肤出血;HBV、CMV感染的ITP患者骨髓巨核细胞代偿增生性反应不及阴性对照组,且巨核细胞成熟停滞阶段更早,少数可导致骨髓抑制。
3、ITP组补体水平下降,PAIgG明显增高,外周血CD4百分比减低,CD8百分比增高,提示了ITP患者不仅有体液免疫紊乱,同时存在细胞免疫异常。
4、感染了HBV、CMV的ITP患者单纯用糖皮质激素治疗疗效较差,CMV感染的ITP患者若伍用更昔洛韦,HBV感染的ITP患者若伍用IFN-α,可缩短病程,提高治疗效果。
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.
引文
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15. Ksouri H, Eljed H, Greco A,et al. Analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay, the amplicor CMV test, and a semi- quantitative polymerase chain reaction test after allogeneic marrow transplantation. Transpl Infect Dis ,2007, 9 (1):16-21.
16.李薇,谢闻悦,陈永强,等.应用间接免疫荧光技术检测人巨细胞病毒PP65抗原的临床意义[J].实用医学杂志,2007,36(9):231-234.
17.叶华,甄宇峰,沈娜君,等.PP65抗原在慢性特发性血小板减少性紫癜CMV感染诊断中的意义[J] .广东医学,2007,28(7):071.
18.张丽娜.巨细胞病毒感染与儿童特发性血小板减少性紫癜紫癜的关系[J].江苏医药,2005,31(2):140.
19.黄爱蓉,潘彤彤,何时军,等.晚发性维生素K缺乏致颅内出血与巨细胞病毒感染的相关性[J] .实用儿科临床杂志,2004,9(6): 491-492.
20.Domiati-Saad R, Margraf LR, Margraf LR, et al.Cytomegalovirus and human herpesvirus 6,but not humam papillomavirus,are present in neonatal giant cell hepatitis and extrahepatic biliary atresia. Pediatric and Developmental Pathology,2000 ,3 (4 )367-373.
21.吴佩琼.小儿巨细胞病毒感染186例[J].实用医学杂志, 2008,(13):2189.
22.叶维法主编.临床肝胆病学.天津:科学技术出版社,1985.89.
23.McMillan R.The pathogenesis of chronic immune (idiopathic) thrombocytopenic purpura. Semin Hematol,2000,37(1 supp11):5-9.
24.宁丽敏.小儿特发性血小板减少性紫癜48例临床分析[J] .中国妇幼保健杂志,2006,21(15):136-137.
25. Bita Behnava, et al. The prevalance of thrombocytopenic in patients with chronic hepatitis B and C. Hep Mon,2006,6(2):67-69.
26.曹祥山,谢晓宝,顾伟英,等.特发性血小板减少性紫癜患者血小板相关抗体表达与预后的关系[J] .苏州大学学报,2006,26(6):1003-1004.
27.Lazarus AH,Ellis JW,et al.Comparison of platelet immunity in patients with SLE and with ITPT.ransfus Sci,2000,22:19-27.
28.刘红,彭贤贵,陈幸华,等.血小板相关抗体检测对血小板减少症的临床利用价值[J] .重庆医学,2003,32(5):557-558.
29.Levin MD,Vries W,Veld J, et al .platelet-bound immunoblotting before and After platelet transfusion:Measurement of in vivo inding. Br J Haematol, 1999, 104: 174-183.
30.Kuwana M, Kaburaki J, Kitasato H, et al. Immunodominant epitopes on glycoproteinⅡb/Ⅲa recognized by autoreactive T cells in patients with immune thrombocytopenic purpura. Blood, 2001; 98:130-139.
31.Olsson B, Andersson PO, Jernas M, et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med, 2003,9: 1123-1124.
32.蒋少华,谢玉桃,谭德明.病毒性肝炎患者的血小板减少机制的探讨[J].中国现代医学杂志,2004,14(11):106-108.
33.Sing g,Butter-Worth L,Chen X.Composition of peripheral blood lympho-cyte populations during different stages of chronic infection with hepatitis B virus[J].J Viral Hepat,1998,5:83～86.
34.Crapnell K, Zanjani ED, Chaudhuri A, et al. Invitro infection of megakaryocytes and their precursors by human cytomegaloviurs [J]. blood, 2000,95(2):487.
35.Hou M, Stocklberg D, Kutti J, et al. Fab Mediated binding of glycoprotein Ib/IX and Iib/IIIa specific antibodies in chronic idiopathic thrombocytopenic purpura. Br J haematol, 1995,91:944-950.
36.Wadenvik H,Stoeklberg D,Hpu M, Platelet protein as autoantibody targets in idiopathic thrombocytopenic purpura. Acta Paediatr Suppl, 1998,424:26-32.
1.Kormans H. Thrombocytopenic purpura during the incubation of hepatitis B[J]. Acta Paediatr Scand, 1991,90:975.
2.Adilson Jose de Almedia,et al.Hepatitis C virus-associated thrombocytopenia: acontrolled rospective,Virologial study.Ann Hematol.2004,83:434-440.
3.Aktepe OC, Yetgin S, Olcay L, et al.Human parvovirus B19 associated with idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol.2004,21(5): 421-6.
4.Emilia G,longo G,Luppi M,et al.Heicobacter pylori eradication can induce recovery in idiopathic thrombocytopenic[J] .blood, 2001, 97(3):812-814.
5.Kitamura K,ohta H,Ihara T,et al.Idiopathic thrombocytopenic purpura after human herpesvirus 6 infection. Lancet.1994,344(8925):830.
6.Silva M,Li X,Cheinquer LH,et al. HCV-associated idiopathic thrombocyt-openic purpura(ITP) . Gastroenterology 1992,102:A889.
7.Pivetti S, Novarino A, Merico F, et al. High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders[J].Br J Haematol, 1996,95:204.
8.Chome JJ, Allard JP, Floret D, et al. Role of cytomegalovirus infection in the incidence of viral acute respiratory in infections in children attending day-carecenters. Eur-J-Clin-Microbiol-Infect-Dis. 2001,20(3):167～172.
9.Cariani E,Pelizzari AM,Rodella A,et al. Immune mediated hepatitis associated aplastic anemia caused by the emergence of a mutant hepatitis B virus undetectable by standard assays[J].J Hepatol, 2007,46(4):743-747.
10.焦西英,钱新宏,郑跃杰,等.儿童特发性血小板减少性紫癜病因学的初步研究[J] .山西医科大学学报,1999,30(3):262.
11.Cines DB,Blanchette VS. Immune thrombocytopenic purpura.N Engl J Med,2002,346:995-1008.
12.Kuwana M, Kaburaki J, Kitasato H, et al. Immunodominant epitopes onglycoproteinⅡb/Ⅲa recognized by autoreactive T cells in patients with immune thrombocytopenic purpura. Blood, 2001, 98:130-139.
13.Rochi F,Cecchi P,Marsciani A,et al. Thrombocytopenic purpura as adverse reaction to recombinant hepatitis B vaccine. Arch Dis Child,1998:78:273.
14.邓家栋,主编.临床血液学上海:上海科学技术出版社,2001,1338.
15.Crapnell K, Zanjani ED, Chaudhuri A, et al. Invitro infection of megakaryocytes and their precursors by human cytomegaloviurs[J].blood, 2000, 95(2):487.
16.Bita Behnava,et al.The prevalance of thrombocytopenic in patients withchronic hepatitis B and C.Hep Mon,2006,6(2):67-69.
17.曹祥山,谢晓宝,顾伟英,等.特发性血小板减少性紫癜患者血小板相关抗体表达与预后的关系[J] .苏州大学学报,2006,26(6):1003-1004.
18.Hou M, Stocklberg D, Kutti J, et al. Fab Mediated binding of glycoprotein Ib/IX and Iib/IIIa specific antibodies in chronic idiopathic thrombocytopenic purpura. Br J haematol ,1995,91:944-950.
19.Wadenvik H,Stoeklberg D,Hpu M, Platelet protein as autoantibody targets in idiopathic thrombocytopenic purpura. Acta Paediatr Suppl, 1998,424:26-32.
20.刘红,彭贤贵,陈幸华,等.血小板相关抗体检测对血小板减少症的临床利用价值[J] .重庆医学2003,32(5):557-558.
21.Levin MD,Vries W,Veld J, et al. platelet-bound immunoblotting before and after platelet transfusion:Measurement of in vivo inding. Br J Haematol 1999,104:174-183.
22.He R,Reid DM,Jones CE,et al.Extracellular epitopes of platelet glycoprotein Ib alpha reactive with serum antibodies from patients with chronic diopathic thrombocytopenic purpura. Blood, 1995, 86:3789-3796.
23.Arfors L,Winiarski J,Lefvert AK.Prevalence of antibodies to cardiolipin in chronic idiopathic thrombocytopenic purpura and reactivity with platelet membrance.Eur J Haematol,1996,56:230-234.
24.李秋兰,林玲.抗心磷脂抗体在自身免疫病的临床应用[J] .福建医科大学学报,2004,38(2):226-227.
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31.Olsson B, Andersson PO, Jernas M, et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med, 2003,9: 1123-1124.
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45.Bussel JB, Mukherjee R, Stone AJ, et al. Apilot study of rhu-IL-11 treatment of refractory ITP. Am J Hematol, 2001,66:172.
46. Perotta A, Sunneberg JA, Scott V, et al. Rituxan in the treatment of chronic idiopathic thrombocytopenic purpur (ITP). Blood,1999,94:14a.
2.Adilson Jose de Almedia,et al. Hepatitis C virus-associated thrombocytopenia:acontrolled rospective,Virologial study,Ann Hematol,2004,83:434-440.
3. Aktepe OC,Yetgin S,Olcay L, et al.Human parvovirus B19 associated with idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol,2004,21(5):421-6.
4. Emilia G,longo G,Luppi M,et al.Heicobacter pylori eradication caninduce recovery inidiopathic thrombocytopenic[J] .blood, 2001,97(3):812-814.
5. Kitamura K,ohta H,Ihara T,et al.Idiopathic thrombocytopenic purpura after human herpesvirus 6 infection.lancet,1994, 344(8925):830.
6.Silva M,Li X,Cheinquer LH,et al.HCV-associated idiopathic thrombocyt-openic purpura(ITP) .Gastroenterology,1992,102:A889.
7.Pivetti S, Novarino A, Merico F, et al. High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders[J].Br J Haematol, 1996,95:204.
8.Cariani E,Pelizzari AM,Rodella A,et al.Immune mediated hepatitis associated aplastic anemia caused by the emergence of a mutant hepatitis B virus undetectable by standard assays[J] .Hepatol, 2007,46(4) :743-747.
9.涂梅峰,邵字鸿,刘鸿,等.肝炎相关再生障碍性贫血的临床特征.中华血液学杂志[J],2005,26(4):239.
10.Rochi F,Cecchi P,Marsciani A,et al.Thrombocytopenic purpura as adverse reaction to recombinant hepatitis B vaccine.Arch Dis Child,1998,78:273.
11.宋爱琴,董增义,庞秀英,等. HBV感染并发ITP病儿临床特征分析[J] .齐鲁医学杂志,2006,21(2):344.
12.焦西英,钱新宏,郑跃杰,等.儿童特发性血小板减少性紫癜病因学的初步研究[J] .山西医科大学学报,1999,30(3):262.
13. Chome JJ, Allard JP, Floret D, et al. Role of cytomegalovirus infection in theincidence of viral acute respiratory in infections in children attending day-carecenters. Eur-J-Clin-Microbiol-Infect-Dis, 2001,20(3):167～172.
14.林孝怡,季育华.人巨细胞病毒pp65蛋白的研究进展[J] .临床输血与检验,2006,8(1):74-75.
15. Ksouri H, Eljed H, Greco A,et al. Analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay, the amplicor CMV test, and a semi- quantitative polymerase chain reaction test after allogeneic marrow transplantation. Transpl Infect Dis ,2007, 9 (1):16-21.
16.李薇,谢闻悦,陈永强,等.应用间接免疫荧光技术检测人巨细胞病毒PP65抗原的临床意义[J].实用医学杂志,2007,36(9):231-234.
17.叶华,甄宇峰,沈娜君,等.PP65抗原在慢性特发性血小板减少性紫癜CMV感染诊断中的意义[J] .广东医学,2007,28(7):071.
18.张丽娜.巨细胞病毒感染与儿童特发性血小板减少性紫癜紫癜的关系[J].江苏医药,2005,31(2):140.
19.黄爱蓉,潘彤彤,何时军,等.晚发性维生素K缺乏致颅内出血与巨细胞病毒感染的相关性[J] .实用儿科临床杂志,2004,9(6): 491-492.
20.Domiati-Saad R, Margraf LR, Margraf LR, et al.Cytomegalovirus and human herpesvirus 6,but not humam papillomavirus,are present in neonatal giant cell hepatitis and extrahepatic biliary atresia. Pediatric and Developmental Pathology,2000 ,3 (4 )367-373.
21.吴佩琼.小儿巨细胞病毒感染186例[J].实用医学杂志, 2008,(13):2189.
22.叶维法主编.临床肝胆病学.天津:科学技术出版社,1985.89.
23.McMillan R.The pathogenesis of chronic immune (idiopathic) thrombocytopenic purpura. Semin Hematol,2000,37(1 supp11):5-9.
24.宁丽敏.小儿特发性血小板减少性紫癜48例临床分析[J] .中国妇幼保健杂志,2006,21(15):136-137.
25. Bita Behnava, et al. The prevalance of thrombocytopenic in patients with chronic hepatitis B and C. Hep Mon,2006,6(2):67-69.
26.曹祥山,谢晓宝,顾伟英,等.特发性血小板减少性紫癜患者血小板相关抗体表达与预后的关系[J] .苏州大学学报,2006,26(6):1003-1004.
27.Lazarus AH,Ellis JW,et al.Comparison of platelet immunity in patients with SLE and with ITPT.ransfus Sci,2000,22:19-27.
28.刘红,彭贤贵,陈幸华,等.血小板相关抗体检测对血小板减少症的临床利用价值[J] .重庆医学,2003,32(5):557-558.
29.Levin MD,Vries W,Veld J, et al .platelet-bound immunoblotting before and After platelet transfusion:Measurement of in vivo inding. Br J Haematol, 1999, 104: 174-183.
30.Kuwana M, Kaburaki J, Kitasato H, et al. Immunodominant epitopes on glycoproteinⅡb/Ⅲa recognized by autoreactive T cells in patients with immune thrombocytopenic purpura. Blood, 2001; 98:130-139.
31.Olsson B, Andersson PO, Jernas M, et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med, 2003,9: 1123-1124.
32.蒋少华,谢玉桃,谭德明.病毒性肝炎患者的血小板减少机制的探讨[J].中国现代医学杂志,2004,14(11):106-108.
33.Sing g,Butter-Worth L,Chen X.Composition of peripheral blood lympho-cyte populations during different stages of chronic infection with hepatitis B virus[J].J Viral Hepat,1998,5:83～86.
34.Crapnell K, Zanjani ED, Chaudhuri A, et al. Invitro infection of megakaryocytes and their precursors by human cytomegaloviurs [J]. blood, 2000,95(2):487.
35.Hou M, Stocklberg D, Kutti J, et al. Fab Mediated binding of glycoprotein Ib/IX and Iib/IIIa specific antibodies in chronic idiopathic thrombocytopenic purpura. Br J haematol, 1995,91:944-950.
36.Wadenvik H,Stoeklberg D,Hpu M, Platelet protein as autoantibody targets in idiopathic thrombocytopenic purpura. Acta Paediatr Suppl, 1998,424:26-32.
1.Kormans H. Thrombocytopenic purpura during the incubation of hepatitis B[J]. Acta Paediatr Scand, 1991,90:975.
2.Adilson Jose de Almedia,et al.Hepatitis C virus-associated thrombocytopenia: acontrolled rospective,Virologial study.Ann Hematol.2004,83:434-440.
3.Aktepe OC, Yetgin S, Olcay L, et al.Human parvovirus B19 associated with idiopathic thrombocytopenic purpura. Pediatr Hematol Oncol.2004,21(5): 421-6.
4.Emilia G,longo G,Luppi M,et al.Heicobacter pylori eradication can induce recovery in idiopathic thrombocytopenic[J] .blood, 2001, 97(3):812-814.
5.Kitamura K,ohta H,Ihara T,et al.Idiopathic thrombocytopenic purpura after human herpesvirus 6 infection. Lancet.1994,344(8925):830.
6.Silva M,Li X,Cheinquer LH,et al. HCV-associated idiopathic thrombocyt-openic purpura(ITP) . Gastroenterology 1992,102:A889.
7.Pivetti S, Novarino A, Merico F, et al. High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders[J].Br J Haematol, 1996,95:204.
8.Chome JJ, Allard JP, Floret D, et al. Role of cytomegalovirus infection in the incidence of viral acute respiratory in infections in children attending day-carecenters. Eur-J-Clin-Microbiol-Infect-Dis. 2001,20(3):167～172.
9.Cariani E,Pelizzari AM,Rodella A,et al. Immune mediated hepatitis associated aplastic anemia caused by the emergence of a mutant hepatitis B virus undetectable by standard assays[J].J Hepatol, 2007,46(4):743-747.
10.焦西英,钱新宏,郑跃杰,等.儿童特发性血小板减少性紫癜病因学的初步研究[J] .山西医科大学学报,1999,30(3):262.
11.Cines DB,Blanchette VS. Immune thrombocytopenic purpura.N Engl J Med,2002,346:995-1008.
12.Kuwana M, Kaburaki J, Kitasato H, et al. Immunodominant epitopes onglycoproteinⅡb/Ⅲa recognized by autoreactive T cells in patients with immune thrombocytopenic purpura. Blood, 2001, 98:130-139.
13.Rochi F,Cecchi P,Marsciani A,et al. Thrombocytopenic purpura as adverse reaction to recombinant hepatitis B vaccine. Arch Dis Child,1998:78:273.
14.邓家栋,主编.临床血液学上海:上海科学技术出版社,2001,1338.
15.Crapnell K, Zanjani ED, Chaudhuri A, et al. Invitro infection of megakaryocytes and their precursors by human cytomegaloviurs[J].blood, 2000, 95(2):487.
16.Bita Behnava,et al.The prevalance of thrombocytopenic in patients withchronic hepatitis B and C.Hep Mon,2006,6(2):67-69.
17.曹祥山,谢晓宝,顾伟英,等.特发性血小板减少性紫癜患者血小板相关抗体表达与预后的关系[J] .苏州大学学报,2006,26(6):1003-1004.
18.Hou M, Stocklberg D, Kutti J, et al. Fab Mediated binding of glycoprotein Ib/IX and Iib/IIIa specific antibodies in chronic idiopathic thrombocytopenic purpura. Br J haematol ,1995,91:944-950.
19.Wadenvik H,Stoeklberg D,Hpu M, Platelet protein as autoantibody targets in idiopathic thrombocytopenic purpura. Acta Paediatr Suppl, 1998,424:26-32.
20.刘红,彭贤贵,陈幸华,等.血小板相关抗体检测对血小板减少症的临床利用价值[J] .重庆医学2003,32(5):557-558.
21.Levin MD,Vries W,Veld J, et al. platelet-bound immunoblotting before and after platelet transfusion:Measurement of in vivo inding. Br J Haematol 1999,104:174-183.
22.He R,Reid DM,Jones CE,et al.Extracellular epitopes of platelet glycoprotein Ib alpha reactive with serum antibodies from patients with chronic diopathic thrombocytopenic purpura. Blood, 1995, 86:3789-3796.
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