再生障碍性贫血患者乙型肝炎病毒感染及其与预后的关系

Study on the Prevalence and Prognosis of Hepatitis B Virus Infection in Patients with Aplastic Anemia

目的研究再生障碍性贫血(AA)患者中乙肝病毒(HBV)感染发生情况及接受免疫抑制治疗(IST)后HBV再激活发生概率,探讨HBV感染与AA预后的关系。方法纳入2006年1月至2016年12月南充市中心医院及川北医学院附属医院AA住院患者245例为研究对象,依据有无HBV感染及感染状况分为HBsAg阳性组(n=36)、HBsAg阴性/抗-HBc阳性组(n=96)及HBsAg阴性/抗-HBc阴性组(n=113),所有入组患者均接受IST治疗,中位随访时间在44个月以上。对不同组别AA患者病情程度进行比较,总结接受IST治疗后HBV再激活情况及所有患者总生存率的差别。结果 1)245例AA患者中132例存在HBV感染,总感染率53.88%,其中36例为HBsAg阳性,96例为HBsAg阴性/抗-HBc阳性;2)3例HBsAg阳性接受预防性抗病毒治疗者无HBV再激活发生,33例HBsAg阳性及96例HBsAg阴性/抗-HBc阳性均未接受预防性抗病毒治疗者中各有1例发生HBV再激活,HBV再激活发生率1.55%(2/129);3)HBsAg阳性组AA患者随访7年,总体存活率84.4%,HBsAg阴性/抗-HBc阴性组AA组患者总体存活率87.5%,HBsAg阴性/抗-HBc阳性组总体存活率81.6%,组间比较差异无统计学意义(P=0.862);纳入研究的全部HBV感染AA患者没有发生与肝炎相关的死亡。结论AA患者的HBV感染率较普通人群增高;有HBV感染的AA患者接受IST治疗后,未发生病毒激活率增加,HBV感染对AA患者预后亦无明显影响。

Objective To investigate the prevalence of hepatitis B virus(HBV)infection in patients with aplastic anemia(AA)and the probability of HBV reactivation after immunosuppressive therapy(IST),and explore the correlation between HBV infection and AA prognosis.Methods A total of 245 AA patients treated from January of 2006 to December of 2016 in Nanchong Central Hospital and Affiliated Hospital of North Sichuan Medical College were selected as the subjects and divided into the HBsAg positive group(n=36),HBsAg negative/anti-HBc positive group(n=96)and HBsAg negative/anti-HBc negative group(n=113).All the patients were treated with IST and followed up with the median time of over 44 months.The illness degrees of AA patients in the different groups were compared and the HBV reactivation after IST and the total survival rates of all the patients were analyzed.Results Firstly,132 out of the 245 AA cases had HBV infection with the infection rate of 53.88%,among which there were 36 HBsAg positive cases and 96 HBsAg negative/anti-HBc positive cases.Secondly,there were no case of HBV reactivation in the 3 HBsAg positive cases with prophylactic antiviral therapy(PAT),one case in the 33 HBsAg positive cases without PAT and one case in the 96 HBsAg negative/anti-HBc positive cases,and the reactivation rate of HBV was 1.55%(2/199)and it was very low.Thirdly,the patients of the HBsAg positive group were followed for 7 years and the overall survival rate was 84.4%.The overall survival rates was 87.5%in the HBsAg negative/anti-HBc negative group and 81.6%in the HBsAg negative/anti-HBc positive group.There were no significant differences between groups(P=0.862).There were no hepatitis-related death among all the AA patients with HBV infection.Conclusion The HBV infection rate is higher among AA patients than among the general population.The AA patients with HBV infection don't have the increased rate of HBV reactivation and the HBV infection has no significant effect on the prognosis of AA patients.