Objective To investigate the effect of cytomegalovirus (CMV) infection on the patho-genesis of infant idiopathic thrombocytopenic purpura (FTP). Methods IgM/DNA of serum CMV were detected in 178 cases of infants ITP in our hospital from June of 2004 to December of 2009. According to the results of positive or negative, they were divided into observation group and control group. Their ages of onset, course of disease, inducing factors, bleeding degrees, lab examinations and outcome were analyzed retrospectively. Results The median ages of observation group (81 cases) and control group (97 cases) were three months and six months respectively; The prodromal infection rate for both groups were 37% and 42% respectively and there was no statistical difference (P >0. 05). The prodromal infection was mainly upper respiratory tract infection; 72% and 75% patients in two groups had vaccination history and there was no statistical difference ( P > 0.05); The degrees of bleeding in two groups had no statistical difference (P >0.05). The platelet counts of over half patients were less than 10 ×109/L when admitted into hospital. The mean values were 12.28 × 109/L and 11.67 × 109/L respectively and showed no statistical difference ( P > 0.05); The bone marrow smears of two groups appeared normal or increased number of megakaryocyte combined with maturation arrest and thrombocyte dysplasia; 86% (31/36) and 81% (26/32) patients in two groups had abnormal immunoglobulin and there was no statistical difference (P > 0.05). After treatment of prednisone and/or venous gamma globulin, the platelet counts of 75 cases (93% ) and 93 cases (96% ) in two groups turned to normal and there was no statistical difference ( P > 0. 05 ). Conclusions CMV infection is very common in small children and may be one of inducing factors for thrombocytopenic purpura. Clinical manifestation of ITP patients has no significant difference whether they have CMY infection or not. Infant ITP with or without CMV infection always shows good response to adrenal cortical hormone/large-dose gamma globulin. However, how to reduce excessive therapy requires further studies.%目的 探讨巨细胞病毒(CMV)感染对婴儿特发性血小板减少性紫癜(ITP)发病的影响.方法 对2004年6月-2009年12月我院收治的178例婴儿ITP患儿,检测血清CMV IgM或DNA,根据其阳性与否分为观察组和对照组,对发病年龄、入院前病程、发病诱因、出血程度、实验室检查及转归进行回顾性分析.结果 观察组81例,中位年龄3个月;对照组97例,中位年龄6个月;两组前驱感染率分别为37％和42％,差异无显著性(P＞0.05),前驱感染主要为上呼吸道感染.两组分别有72％和75％在发病前有预防接种史,两组差异无显著性(P＞0.05).两组临床出血程度比较差异无显著性(P＞0.05).入院时两组均有半数以上血小板计数＜ 10.00×109/L,其均值分别为12.28×109/L和11.67×109/L,两者比较差异无显著性(P＞0.05).两组骨髓涂片巨核细胞数均正常或增多,并有成熟障碍和血小板生成不良;两组分别有86％( 31/36)和81％ (26/32)存在免疫球蛋白异常,差异无显著性(P＞0.05).经泼尼松和(或)静脉注射用丙种球蛋白治疗后,观察组有75例(93％)、对照组有93例(96％)血小板于2周内恢复正常,两组比较差异无显著性(P＞0.05).结论 婴儿ITP中CMV感染在小月龄患儿中常见,可能是血小板减少性紫癜的诱发因素之一.CMV感染的ITP患儿其临床经过与非CMV感染者无明显差异.婴儿ITP无论有无CMV感染,均对肾上腺皮质激素或大剂量丙种球蛋白治疗有良好反应,但如何减少过度治疗有待于进一步研究.
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