儿童幽门螺杆菌感染与免疫性血小板减少症的因果探究及预后影响因素分析

周晓阳; 严媚; 岳迎宾; 海丽其古丽·努日丁; 王学梅; 程永凤; 吴春灿; 刘玉

doi:10.7499/j.issn.1008-8830.2412180

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中国当代儿科杂志 ›› 2025, Vol. 27 ›› Issue (9) : 1105-1112. DOI: 10.7499/j.issn.1008-8830.2412180

论著·临床研究

儿童幽门螺杆菌感染与免疫性血小板减少症的因果探究及预后影响因素分析

作者信息 +

Causal relationship between Helicobacter pylori infection and childhood immune thrombocytopenia and influencing factors for prognosis

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摘要

目的通过孟德尔随机化（Mendelian randomization, MR）探索幽门螺杆菌（Helicobacter pylori, Hp）感染与免疫性血小板减少症（immune thrombocytopenia, ITP）的因果关系，并采用临床研究探讨Hp感染与ITP慢性化（chronic ITP, cITP）的关系。方法从全基因组关联分析数据集中选取与Hp感染有显著相关性的单核苷酸多态性位点作为遗传工具变量。采用MR分析模型，探究Hp感染与ITP之间的因果关系。回顾性分析2020年1月—2023年12月新疆医科大学第一附属医院初诊的316例ITP患儿的临床资料，随访1年，采用多因素logistic回归分析cITP的危险因素。结果逆方差加权法分析显示，Hp感染是ITP发病的危险因素（OR=1.280，95%CI：1.098~1.492，P=0.002）。本MR研究不存在异质性和多效性（P>0.05），模型稳定。“留一法”敏感性分析（P>0.05）验证了结果的可靠性。多因素logistic回归分析显示，Hp感染为cITP发生的独立危险因素（OR=7.916，95%CI：3.327~18.832，P<0.001）。结论 Hp感染是ITP发病的危险因素，且为儿童cITP的独立危险因素。

Abstract

Objective To investigate the causal relationship between Helicobacter pylori (Hp) infection and immune thrombocytopenia (ITP) using Mendelian randomization (MR), as well as the association between Hp infection and chronic ITP (cITP) through a clinical study. Methods The datasets from genome-wide association studies were used to select the single nucleotide polymorphism loci significantly associated with Hp infection as genetic instrumental variables. The MR analysis model was used to investigate the causal relationship between ITP and Hp infection. A retrospective analysis was conducted on the medical data of 316 children with newly diagnosed ITP at the First Affiliated Hospital of Xinjiang Medical University from January 2020 to December 2023. The children were followed up for 1 year, and a multivariate logistic regression analysis was used to investigate the risk factors for cITP. Results The inverse variance weighted analysis revealed that Hp infection was significantly associated with an increased risk of ITP (OR=1.280, 95%CI: 1.098-1.492, P=0.002). There was no heterogeneity or pleiotropy in this MR study (P>0.05), and the model was stable. The "leave-one-out" sensitivity analysis verified the reliability of the results. The multivariate logistic regression analysis demonstrated that Hp infection was an independent risk factor for progression to cITP (OR=7.916, 95%CI: 3.327-18.832, P<0.001). Conclusions Hp infection is a risk factor for the onset of ITP and is an independent risk factor for cITP in children.

导出引用

周晓阳, 严媚, 岳迎宾, 等. 儿童幽门螺杆菌感染与免疫性血小板减少症的因果探究及预后影响因素分析[J]. 中国当代儿科杂志. 2025, 27(9): 1105-1112 https://doi.org/10.7499/j.issn.1008-8830.2412180

Xiao-Yang ZHOU, Mei YAN, Ying-Bin YUE, et al. Causal relationship between Helicobacter pylori infection and childhood immune thrombocytopenia and influencing factors for prognosis[J]. Chinese Journal of Contemporary Pediatrics. 2025, 27(9): 1105-1112 https://doi.org/10.7499/j.issn.1008-8830.2412180

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