肝炎相关再生障碍性贫血的临床特征及其6个月转归的影响因素

摘要/Abstract

摘要： 目的观察肝炎相关再生障碍性贫血(HAAA)的临床特征及6个月转归的影响因素。方法回顾性分析2013年11月至2018年5月150例HAAA患者经支持治疗及免疫抑制治疗后的临床特征,观察6个月的疗效。采用多因素logistic回归分析HAAA患者治疗6个月转归的独立影响因素。结果 150例HAAA患者中,男性占80%,年龄≤25岁者占90%,肝炎至再生障碍性贫血(AA)的发病时间为(42.5±10.4)d,AA发病至治疗时间为(17.7±4.1)d,AA发生在肝炎恢复期或在肝炎恢复后的发病率为78%。甲型肝炎占5.33%,乙型肝炎占7.33%,丙型肝炎占2.00%,戊型肝炎占5.33%,不明原因占80.00%;重型AA占48.00%,极重型AA占38.67%,非重型AA占13.33%。AA起病3个月内出现感染症状占70%。150例HAAA患者均接受为期6个月的支持治疗及免疫抑制治疗,有效率为56.67%,其中PR占33.33%,CR占23.33%,无效占43.33%。多因素logistic回归分析显示,性别、AA严重程度、肝炎时血清总胆红素水平、骨髓中成熟单核细胞比例是HAAA患者治疗6个月转归的独立影响因素(P<0.05)。结论 HAAA多发于年轻男性患者,主要表现为重型和极重型AA,大多属非甲、乙、丙、戊型肝炎相关的AA,早期感染风险高,预后与性别、AA严重程度、肝炎时血清TBil水平、骨髓中成熟单核细胞比例等因素有关。

关键词: 肝炎相关再生障碍性贫血, 肝炎, 再生障碍性贫血, 免疫抑制

Abstract: Objective In order to investigate the clinical characteristics of 150 cases of hepatitis-associated aplastic anemia (HAAA) and the factors influencing 6-month prognosis of them. Methods Retrospective analysis was carried out in 150 patients with HAAA admitted to our hospital from November 2016 to November 2018. All patients were treated with supportive and immunosuppressive therapy. The clinical features and efficacy of 6-month treatment were observed. Multivariate logistic regression analysis was used to analyze the independent factors influencing HAAA patients′ outcomes after 6 months of treatment. Results Among 150 HAAA patients, 80.00% were males, 90.00% were younger than 25 years old. The onset internal from hepatitis to aplastic anemia (AA) was (42.50 ± 10.35) days, the interval between the onset and treatment of AA was (17.72 ± 4.10) days, and 78.00% of AA occurred during or after the recovery stage of hepatitis. Among these patients, 5.33% were diagnosed as hepatitis A, 7.33% as hepatitis B, 2.00% as hepatitis C, 5.33% as hepatitis E, and 80.00% as unidentified hepatitis. As for AA, 48.00% were diagnosed as severe AA (SAA), 38.67% as very severe AA (VSAA), and 13.33% as non-severe AA. Within 3 months of AA, 70.00% patients showed clinical symptoms of infection. The effective rate of 150 HAAA patients receiving 6-month supportive and immunosuppressive therapy was 56.67%, of which partial response accounted for 33.33%, and complete response 23.33%. Multivariate logistic regression analysis showed that gender, severity of AA, serum total bilirubin (TBil) level during hepatitis, and the proportion of mature monocytes in bone marrow were independent factors influencing the prognosis of HAAA patients after 6 months of treatment (P<0.05). Conclusion HAAA mostly occurs in young male patients, with unidentified hepatitis, mainly manifested as SAA and VSAA. The risk of early infection in HAAA is high. The prognosis is poor, which is related to gender, severity of AA, serum TBIL level in hepatitis, and the proportion of mature monocytes in bone marrow.

Key words: Hepatitis-associated aplastic anemia, Hepatitis, Aplastic anemia, Immunosuppression

于轩, 李文华, 安冬颖, 王一凡. 肝炎相关再生障碍性贫血的临床特征及其6个月转归的影响因素[J]. 肝脏, 2020, 25(1): 24-27.

YU Xuan, LI Wen-hua, AN Dong-ying, WANG Yi-fan. Clinical characteristics and factors influencing 6-month prognosis of 150 patients with hepatitis-associated aplastic anemia[J]. Chinese Hepatolgy, 2020, 25(1): 24-27.

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