CAJ | 학술논문

目的探讨病毒血清学标志物阴性的肝炎相关性再生障碍性贫血(HAA)和乙型病毒性肝炎(乙型肝炎)合并再生障碍性贫血(AA)的临床特征及疗效.方法回顾性分析我院319例AA中5例HAA患者(A组)发病时临床资料及免疫抑制(IST)的效果,并与17例乙型肝炎合并AA(B组)患者资料进行比较.结果 A组起病急骤,均表现为重型AA Ⅰ型(SAA-Ⅰ),中位年龄22岁,中位随访时间20(14 ～36)个月,3例(60％)基本治愈.B组中位随访时间32(10 ～67)个月,总有效率82.3％,复发2例,两组有效率、病死率及复发率差异均无统计学意义.A组患者肝炎距AA时间短[(4.00±2.94)个月与(92.00 ±26.56)个月,P=0.000)、对IST起效更快[(2.00±0.29)个月与(4.50±2.01)个月,P=0.018]和T细胞异常程度更重,两组患者在治疗过程中无明显肝损伤或乙型肝炎暴发感染.结论病毒血清学标志物阴性的HAA构成比为1.56％,常在肝炎后4个月发病呈SAA-Ⅰ型,T细胞异常程度更重及IST起效更快等与乙型肝炎合并AA不同.不论AA前的肝炎抑或AA合并乙型肝炎均不影响早期IST疗效,乙型肝炎病毒感染可能与AA发病无关.
목적 탐토병독혈청학표지물음성적간염상관성재생장애성빈혈(HAA)화을형병독성간염(을형간염)합병재생장애성빈혈(AA)적림상특정급료효.방법 회고성분석아원319례AA중5례HAA환자(A조)발병시림상자료급면역억제(IST)적효과,병여17례을형간염합병AA(B조)환자자료진행비교.결과 A조기병급취,균표현위중형AA Ⅰ형(SAA-Ⅰ),중위년령22세,중위수방시간20(14 ～36)개월,3례(60％)기본치유.B조중위수방시간32(10 ～67)개월,총유효솔82.3％,복발2례,량조유효솔、병사솔급복발솔차이균무통계학의의.A조환자간염거AA시간단[(4.00±2.94)개월여(92.00 ±26.56)개월,P=0.000)、대IST기효경쾌[(2.00±0.29)개월여(4.50±2.01)개월,P=0.018]화T세포이상정도경중,량조환자재치료과정중무명현간손상혹을형간염폭발감염.결론 병독혈청학표지물음성적HAA구성비위1.56％,상재간염후4개월발병정SAA-Ⅰ형,T세포이상정도경중급IST기효경쾌등여을형간염합병AA불동.불론AA전적간염억혹AA합병을형간염균불영향조기IST료효,을형간염병독감염가능여AA발병무관.
Objective To investigate the clinical features and effect of immunosuppressive therapy (IST) on hepatitis associated aplastic anemia(HAA) patients with seronegative virus markers(group A) and aplastic anemia (AA) patients complicating Hepatitis B Virus (HBV) infection (group B).Methods The clinical information of 5 patients diagnosed with HAA and 17 cases AA patients with HBV infection from January 2002 to March 2011 were collected including clinical presentations,blood routine,bone marrow (BM) examinations,viral serology,T cell repertoire and outcomes of IST.Results The clinical feature of patients with HAA showed a rapid onset.And all were late AAI type.The median age of patients was 22 years old and the median follow-up period was 20 months(14-36 months).Three cases (60％) were cured.As to Group B,the median follow-up periods was 32 months(10-67 months).The total efficiency rate was 82.3％,and 2 cases were re-occurred.There were no significantly different in terms of efficiency rate,death rate and reoccurred rate.The period from hepatitis to AA was shorter ((4.00 ± 2.94) months vs.(92.00 ± 26.56) months,P =0.000),and to IST faster onset((2.00 ± 0.29) months vs.(4.50 ± 2.01) months,P =0.018) as well as T cell abnormalities extent was heavier in patients in group A.There was no significantly different between two groups in terms of hepatitis B outbreaks of infection during treatment.Conclusion Whether pre-AA status or AA with hepatitis B did not affect the efficacy of early IST.HBV infection may not be independent of the incidence of AA.