儿童肝炎相关再生障碍性贫血5例分析

Analysis of hepatitis associated aplastic anemia in 5 children

目的探讨儿童肝炎相关再生障碍性贫血(HAAA)的临床特点、治疗及预后。方法回顾分析5例HAAA患儿的临床资料。结果 5例患儿,男4例、女1例,中位年龄为10岁(7~13岁);5例患儿急性肝炎期间甲、乙、丙、戊肝炎病毒检测均为阴性,其中2例行微小病毒B19抗体、EB病毒检测均为阴性;T淋巴细胞亚群示CD4^+T细胞比例、CD4^+/CD8^+比值降低,CD8^+T细胞比例升高。3例以抗胸腺细胞球蛋白联合环孢素免疫抑制治疗2例完全缓解,1例死于肺部真菌感染;1例单用环孢素免疫抑制治疗,部分缓解;1例放弃治疗后失访。结论儿童HAAA可由病毒血清学阴性的肝炎引起,存在T淋巴细胞免疫紊乱,免疫抑制治疗有效。

Objective To explore the clinical feature,treatment and prognosis of hepatitis associated aplastic anemia(HAAA)in children.Method The clinical data of5children with HAAA were retrospectively analyzed.Results There were5patients(4males and1female)with median age of10years(7~13years).The detection of hepatitis A,B,C,and E were allnegative in these5children during their acute hepatitis period.In2children,parvovirus B19antibody and EB virus were negativeand the proportion of CD4+T cells and the ratio of CD4+/CD8+were decreased,and the proportion of CD8+T cells was increasedby T-lymphocyte subsets analysis.Three children were treated with anti-thymocyte globulin combined with cyclosporine,2ofwhom achieved complete remission and1died of pulmonary fungal infection.One child was treated with cyclosporine only andachieved partial remission.One child lost follow-up after giving up treatment.Conclusion HAAA in children can be caused byviral seronegative hepatitis,and usually has T lymphocyte immune disorders.Immunosuppressive therapy is effective..