结核感染继发自身免疫性溶血性贫血四例临床分析

Secondary autoimmune hemolytic anemia in patients with tuberculosis： a report of 4 cases

回顾性分析2006年1月至2015年1月收治的4例结核继发的自身免疫性溶血性贫血（AIHA）患者的临床特点及血清学、骨髓检查结果、影像学资料等，并对患者的治疗方案及预后进行电话随访。4例AIHA患者的年龄为58～80岁，血红蛋白水平最低值为31—73g/L，Coomb试验均阴性。4例患者糖皮质激素治疗效果均不佳，均在确诊后立即接受含有异烟肼、乙胺丁醇、利福平的抗结核方案治疗。1例患者治疗1周后因结核累及中枢神经系统，病情过重死亡；2例患者治疗6个月后血红蛋白水平恢复正常，停用糖皮质激素；1例患者治疗9个月后血红蛋白水平恢复正常，但仍需要小剂量糖皮质激素维持治疗。AIHA是结核感染的罕见并发症，可能危及生命，及早诊断并进行抗结核治疗有助于改善预后。

Medical charts of tuberculotic patients with secondary autoimmune hemolytic anemia （AIHA） admitted to Peking Union Medical College Hospital （PUMCH）from 2006 to 2015 were retrospectively reviewed. Four cases with complete information of laboratory tests, imaging findings and bone marrow results were included. Therapy regimens and outcomes of survival were followed by phone call if needed. Ages at diagnosis of AIHA were 58 - 80 years old, hemoglobin levels were 31 - 73 g/L, Coomb tests were negative in all eases. Therapy of cortical steroid did not work, while auti-TB therapy （ including isoniazid, rifampicin, ethambutol） significantly improved hemoglobin to normal level in three cases during six to nine months. One case died within one week, for progressive TB to central neurological system. Asone of rare complications of TB, AIHA may be fatal. Early diagnosis and appropriately anti-TB therapy is helpful for good outcomes.