İmmün trombositopenik purpura tanılı hastalarda Helicobacter Pylori insidansı ve Helicobacter Pylori eradikasyon tedavisinin trombosit sayısı üzerine etkisi
Loading...
Date
2010
Authors
Pekgöz, Murat
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
İmmün trombositopenik purpura (idiyopatik trombositopenik purpura, primer trombositopenik purpura) edinsel trombositopeniye yol açan nedenlerden bir tanesidir. Hastalığın meydana gelmesinde trombosit membranına karşı çeşitli antikorlar ile immün komplekslerin oluşması ve bunun sonucunda trombositlerin retiküloendotelyal sistemde yıkımı sözkonusudur. İmmün reaksiyonları başlatan otoimmün hastalıklar, genetik yatkınlık, ilaç kullanımı, çeşitli enfeksiyonlar gibi birçok sebep bulunmaktadır. Helicobacter Pylori midede yerleşip gastrit, ülser ve MALT lenfoma gibi birçok gastrointestinal hastalığa yol açabilen bir bakteridir. Son yıllarda immün trombositopenik purpuraya neden olabileceği ve bakterinin ortadan kaldırılması ile trombosit sayısının yükselebileceğine dair görüşler ileri sürülmektedir. Prospektif olarak yapılan bu çalışmada; immün trombositopenik purpuralı hastalarda Helicobacter Pylori sıklığı, enfekte olguların özellikleri ve bakteri eradikasyonundan sonra trombosit sayısındaki değişimin değerlendirmesi amaçlanmıştır. Çalışmamız Temmuz 2009 ? Nisan 2010 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları Ana Bilim Dalı Hematoloji Bilim Dalı'nda takip ve tedavi edilmekte olan toplam 103 hasta ile yapıldı. İmmün trombositopenik pupuralı olgular gastrik şikayetleri ile değerlendirildi ve Helicobacter Pylori yönünden araştırılması gerekip gerekmediğine karar verildi. Helicobacter Pylori için IgG düzeyine bakıldı ve üre nefes testi yapıldı. Üre nefes testi pozitif sonuçlanan hastalara standart eradikasyon tedavisi verildi. Helicobacter Pylori eradikasyonu sağlanan hastalarda trombosit yanıtı açısından trombosit düzeyleri ölçüldü. İmmün trombositopenik purpuralı olgularda Helicobacter Pylori sıklığı %63,5 olarak saptandı. Bu oran sağlıklı populasyondaki Helicobacter Pylori sıklığından daha düşüktü. Eradikasyon tedavisi olguların %94,5'inde başarılı oldu. Bakteri eradikasyonu sağlanan olguların %60'ında anlamlı düzeyde trombosit sayısında artış tespit edildi. %40'ında ise trombosit değerlerinde artış belirlenmedi. Çalışmamızda saptanan bakteri eradikasyonundan sonrası trombosit yanıt oranı, literatürde mevcut çalışmalardaki yanıt oranlarından nispeten daha yüksekti. Sonuç olarak; immün trombositopenik purpuralı hastalarda Helicobacter Pylori eradikasyon tedavisi birincil basamak tedavi seçenekleri arasında yer almasa da alternatif tedavi seçeneklerinden birisi olabilir.
Immune thrombocytopenic purpura (idiopathic thrombocytopenic purpura, primary thrombocytopenic purpura) is one of the reasons that result in acquired thrombocytopenia. The formation of immune complexes with various antibodies against the thrombocyte membrane and as a consequence destruction of the thrombocytes in the reticuloendothelial system is in question in the formation of the disease. Many factors are included such as autoimmune diseases that initiate immune reactions, genetic predisposition, medications, and various infections. Helicobacter Pylori is a bacterium that settles in the stomach and that may lead to many gastrointestinal diseases like gastritis, ulcer and MALT lymphoma. In recent years, opinions on the subject that it can lead to immune thrombocytopenic purpura and the thrombocyte count may be raised with the elimination of the bacteria have been suggested. In this prospective study; the evaluation of Helicobacter Pylori incidence, characteristics of the infected cases and the change in the thrombocyte count after the eradication of the bacteria in patients with immune thrombocytopenic purpura was intended. Our study was performed between July 2009 and April 2010 on 103 patients followed and treated at Uludağ University, Faculty of Medicine, Department of Internal Diseases, Discipline of Hematology. The patients with immune thrombocytopenic purpura questioned for gastric complaints and decided if they needed more examination about Helicobacter Pylori. We measured IgG level and did urea breath test for Helicobacter Pylori. Standard eradication treatment was assigned to the patients with positive results on the urea breath test. Thrombocyte levels of patients who have been provided Helicobacter Pylori eradication were measured in respect to thrombocyte response. Helicobacter Pylori incidence in patients with immune thrombocytopenic purpura was determined to be 63,5%. This ratio was lower than the Helicobacter Pylori incidence in the healthy population. The eradication treatment was successful in 94,5% of our cases. Thrombocyte counts were detected to be significantly increased in 60% of cases with the eradication of the bacteria, whereas no change was detected in 40% of cases. In our study; the thrombocyte response ratio after the eradication of the bacteria was more than the other studies in literature. As a result; though eradication treatment of Helicobacter Pylori is not among the primary care treatment options in patients with immune thrombocytopenic purpura, it may be one of the alternative treatment options.
Immune thrombocytopenic purpura (idiopathic thrombocytopenic purpura, primary thrombocytopenic purpura) is one of the reasons that result in acquired thrombocytopenia. The formation of immune complexes with various antibodies against the thrombocyte membrane and as a consequence destruction of the thrombocytes in the reticuloendothelial system is in question in the formation of the disease. Many factors are included such as autoimmune diseases that initiate immune reactions, genetic predisposition, medications, and various infections. Helicobacter Pylori is a bacterium that settles in the stomach and that may lead to many gastrointestinal diseases like gastritis, ulcer and MALT lymphoma. In recent years, opinions on the subject that it can lead to immune thrombocytopenic purpura and the thrombocyte count may be raised with the elimination of the bacteria have been suggested. In this prospective study; the evaluation of Helicobacter Pylori incidence, characteristics of the infected cases and the change in the thrombocyte count after the eradication of the bacteria in patients with immune thrombocytopenic purpura was intended. Our study was performed between July 2009 and April 2010 on 103 patients followed and treated at Uludağ University, Faculty of Medicine, Department of Internal Diseases, Discipline of Hematology. The patients with immune thrombocytopenic purpura questioned for gastric complaints and decided if they needed more examination about Helicobacter Pylori. We measured IgG level and did urea breath test for Helicobacter Pylori. Standard eradication treatment was assigned to the patients with positive results on the urea breath test. Thrombocyte levels of patients who have been provided Helicobacter Pylori eradication were measured in respect to thrombocyte response. Helicobacter Pylori incidence in patients with immune thrombocytopenic purpura was determined to be 63,5%. This ratio was lower than the Helicobacter Pylori incidence in the healthy population. The eradication treatment was successful in 94,5% of our cases. Thrombocyte counts were detected to be significantly increased in 60% of cases with the eradication of the bacteria, whereas no change was detected in 40% of cases. In our study; the thrombocyte response ratio after the eradication of the bacteria was more than the other studies in literature. As a result; though eradication treatment of Helicobacter Pylori is not among the primary care treatment options in patients with immune thrombocytopenic purpura, it may be one of the alternative treatment options.
Description
Keywords
İmmün trombositopenik purpura, Primer trombositopeni, Helicobacter pylori, Eradikasyon tedavisi, Trombosit yanıtı, Immune thrombocytopenic purpura, Eradication treatment, Thrombocyte response
Citation
Pekgöz, M. (2010). İmmün trombositopenik purpura tanılı hastalarda Helicobacter Pylori insidansı ve Helicobacter Pylori eradikasyon tedavisinin trombosit sayısı üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.