病毒性肝炎合并再生障碍性贫血的临床研究

Clinical study on viral hepatitis combined with aplastic anemia

目的 研究病毒性肝炎合并再生障碍性贫血的临床特征，探讨这类疾病的临床转归及治疗方法。方法 对2004年4月至2009年9月在地坛医院住院诊断为病毒性肝炎并且合并再生障碍性贫血的25例患者进行回顾性分析，本组病例中再生障碍性贫血诊断均通过骨穿确诊，收集患者的临床资料，包括肝病病史、药物过敏史、住院期间用药史、生化检查等等，对其进行描述性分析。结果 25例病毒性肝炎患者在经组织病理学诊断同时合并再生障碍性贫血，其中17例为男性,8例为女性；12例为慢性乙型肝炎患者，4例为慢性丙型肝炎患者，l例为急性戊型肝炎患者，l例为巨细胞病毒感染所致肝炎，7例为未分型病毒性肝炎患者，7例诊断为重型肝炎；仅有3例患者在入院前有干扰素短期使用史，其余患者未使用影响血象药物；治疗过程中使用集落细胞细胞刺激因子者6例，使用丙种球蛋白者9例，使用糖皮质激素者3例，使用促红素者1例，仅用口服药物升血细胞治疗者2例，输红细胞者6例，输血小板者2例；好转出院者20例，自动出院者3例，因重型肝炎其他合并症死亡者2例。结论 病毒性肝炎合并再生障碍性贫血的治疗以治疗原发性肝病及核苷类似物抗病毒治疗为主，血液病方面对症支持治疗，随肝病好转血液病逐渐同时恢复，预后较好。

Objective To study the clinical features, outcomes and treatments of viral hepatitis combined with aplastic anemia. Methods25 cases diagnosed as viral hepatitis combined with aplastic anemia in Beijng Ditan Hospital between April 2004 and September 2009 were retrospectively analyzed. In this group of patients aplastic anemia was finally diagnosed by bone marrow aspiration. We collected clinical data of these patients, including a history of liver disease, drug allergies, hospital medication history, laboratory data, and then performed descriptive analysis. Results25 patients with viral hepatitis were diagnosed as complicated with aplastic anemia by histopathological data. Among these patients, 17 were male and 8 were women. Viral hepatitis included： chronic hepatitis B （ 12 cases）, chronic hepatitis C （4 cases）, acute hepatitis E （ 1 case）, hepatitis caused by CMV infection （ 1 case）, and unclassified hepatitis （7 cases）. Among these patients, 7 were diagnosed as severe hepatitis. Considering previous history, only 3patients had history of short-term interferon therapy before hospitalization, and the remaining patients did not use drug that affects blood system. Treatments were as followings： using colony stimulating factor in 6patients, gamma globulin in 9 patients, glucocorticoids in 3 patients, erythropoietin in 1 patient, only oral drug to raise erythrocytes in 2 patients, red blood cells transfusion in 6 patients, platelets transfusion in 2patients. As for clinical outcomes, 20 patients acquired improved condition and were discharged, 3 patients were discharged voluntarily and 2 patients died of severe hepatitis combined with other complications.Conclusion Main treatments of viral hepatitis combined with aplastic anemia were to treat primary hepatopathy and nucleoside analogue-based antiviral therapy, to provide symptomatic and supportive treatment for blood diseases. Blood diseases would recover simultaneously while liver disease was improved, and the prognosis was good.