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目的 了解肝炎相关再生障碍性贫血(HAAA)在重型再生障碍性贫血(SAA)中所占比例并探讨其临床特征。方法 观察近五年我科新诊治的SAA患者中HAAA所占比例,并采用病例对照方法探讨HAAA患者与非肝炎相关的SAA患者在临床表现、血常规、骨髓象、病毒血清学表现、肝功能检测结果、T淋巴细胞免疫功能及疗效和预后方面的异同。结果 ①HAAA占SAA的比例为3. 3%。②HAAA与非肝炎相关的SAA患者治疗前血常规、骨髓象、成分输血量无明显差异; 13例HAAA中12例(92. 3% )甲、乙、丙型肝炎病毒检查阴性, 1例( 7. 7% )乙型肝炎病毒表面抗原(HBsAg)、e抗原(HBeAg)阳性; 12例(92. 3% )HAAA患者在急性黄疸型肝炎后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平明显下降时发病;HAAA组CD4+淋巴细胞比例显著降低(P<0. 05 ),CD8+淋巴细胞比例显著增高(P<0. 05),CD4 /CD8比值显著降低(P<0. 05);治疗后6个月内, 与非肝炎相关的SAA比较,HAAA组早期感染率显著增高(84. 6%对42. 3%,P<0. 05)、感染相关病死率显著增高(61. 5%对15. 4%,P<0. 05);HAAA组2年生存率显著降低(16. 6%对83. 2%,P<0. 01)。结论 HAAA约占同期SAA3. 3%;大多数HAAA可能由非甲、非乙、非丙型肝炎病毒所引起;与非肝炎相关的SAA相比,HAAA患者T淋巴细胞免疫异常更明显,?
Objective To investigate the share of HAAA in patients with severe aplastic anemia (SAA) and to investigate its clinical features. Methods The proportion of HAAA in newly diagnosed SAA patients in our department in the past five years was observed. The clinical manifestations, blood tests, bone marrow biopsy, serological manifestations and liver function of HAAA patients and non-hepatitis SAA patients were investigated by case-control study. Test results, T lymphocyte immune function and efficacy and prognosis of similarities and differences. Results ①HAAA accounted for the proportion of SAA was 3.3%. There was no significant difference in HAAA and non-hepatitis-related SAA before treatment in patients with SAA. Blood samples were collected from 12 patients (92.3%) with negative hepatitis A, B and hepatitis C virus and 1 (7 .7%) were positive for hepatitis B virus surface antigen (HBsAg) and e antigen (HBeAg); 12 cases (92.3%) HAAA patients after acute jaundice hepatitis alanine aminotransferase (ALT), aspartate aminotransferase (P <0.05). The ratio of CD4 / CD8 in HAAA group was significantly lower than that in HAAA group (P <0.05). The proportion of CD8 + lymphocytes in HAAA group was significantly lower than that in HAAA group (P <0.05). 05). Compared with non-hepatitis SAA, the early infection rates in HAAA group were significantly higher (84.6% versus 42.3%, P <0.05), and the infection-related mortality rates were significantly higher 61.5% vs 15.4%, P <0.05). The 2-year survival rate of HAAA group was significantly lower (16.6% versus 83.2%, P <0.01). Conclusion HAAA accounts for about 3. 3% of SAA in the same period. Most of the HAAA may be caused by non-A, non-B and non-C hepatitis viruses. Compared with non-hepatitis SAA, T lymphocyte immune abnormalities in HAAA patients are more obvious.