肾综合征出血热并发急性造血功能停滞的临床观察

Clinical analysis of hemorrhagic fever with renal syndrome cases complicated with acute anhemopoisis

目的观察肾综合征出血热（HFRS）并发急性造血功能停滞（AAH）的临床特点、疗效和预后。方法对18例HFRS并发AAH患者的临床特点进行回顾性分析。结果18例HFRS患者，男10例，女8例，年龄14～55岁，发病第9～25天出现不规则发热、突发性贫血和多部位出血，外周血WBC降至（2．3～3．2）×10^9／L，PLT降至（23～31）×10^9／L，RBC降至（2．23～2．79）×10^12／L，Hb降至52～67g／L，网织红细胞0～0．002，骨髓穿刺（56次）示红细胞系增生降低，粒、红细胞比例明显升高，粒细胞系和巨核细胞系增生降低。采用糖皮质激素和输血为主的综合性治疗措施，26～60d治愈。结论汉坦病毒感染可并发AAH，其预后良好。

Objective To investigate the clinical features, treatment response and prognosis of patients with severe hemorrhagic fever with renal syndrome and complicated with acute anhemopoisis. Methods The clinical features of 18 patients with hemorrhagic fever with renal syndrome complicated with acute anhemopoisis were retrospectively analyzed. Results The clinical manifestations of the 18 adult patients （10 males and 8 females, age ranged from 14 to 55 years） with hemorrhagic fever with renal syndrome showed irregular fever, abrupt anemia and multiple sites hemorrhage at the severe stage （9- 25 days after the onset）. Peripheral leucocytes counts reduced to （2.3-3.2）× 10^9/L, platelet to （23-31）× 10^9/L, erythrocytes to （2.23-2.79） × 10^12/L , hemoglobulin to 52- 67 g/L and reticulocyte to 0- 0. 002. Bone marrow test results showed that the hyperplasia of erythrocytes series decreased. The ratio of granulocyte to erythrocyte was significantly elevated, while granulocyte and megalocaryocyte series decreased. The specific manifestations of acute anhemopoiesis were abrupt anemia, irregular fever and multiple sites hemorrhage. The major combined treatments were corteeosteroids and blood transfusion. These patients recovered at 26-60 days after the onset of the disease. Conclusions Hantaan virus could attack human bone marrow ceils and induce cytopathogenie effect. In the course of hemorrhagic fever with renal syndrome, acute anhemopoisis could occur. The prognosis of these complicated cases is usually favorable.