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1例41岁女性患者,因慢性乙型病毒性肝炎肝硬化入院,给予还原型谷胱甘肽1.2 g,1次/d静脉滴注;重组人干扰素α-2b(rhIFNα-2b)500万U,1次/d肌内注射。用药1周后实验室检查:白细胞1.9×109/L,中性粒细胞0.48×109/L,血红蛋白118 g/L,红细胞3.7×1012/L,血小板81×109/L。停用rhIFNα-2b,继续使用其他药物,并加用重组人粒细胞巨噬细胞集落刺激因子75μg,1次/d皮下注射。治疗第5天实验室复查:白细胞4.8×109/L,中性粒细胞3.12×109/L,血红蛋白118 g/L,红细胞3.8×1012/L,血小板61×109/L。再次给予rhIFNα-2b,剂量减为隔日1次。再次给药10 d后,患者持续发热,伴胸闷、呕吐。实验室检查:白细胞0.1×109/L,中性粒细胞未检出,血小板20×109/L,血红蛋白92 g/L,红细胞3.3×1012/L。立即停用rhIFNα-2b,给予对症治疗。根据临床症状和骨髓穿刺术检查结果,诊断为再生障碍性贫血。遂加用人免疫球蛋白和糖皮质激素治疗。第15天患者血小板3.0×109/L,血培养检出肺炎克雷伯菌。第17天患者突然出现呼吸困难,水肿、周身瘀点及瘀斑。第19天患者情况恶化,经抢救无效死亡。
A 41-year-old female patient was admitted to hospital for cirrhosis due to chronic hepatitis B and received 1.2 g of reduced glutathione once a day. Recombinant human interferon α-2b (500 million) U, 1 times / d intramuscular injection. One week after treatment, the laboratory tests showed that the number of leukocytes 1.9 × 109 / L, neutrophils 0.48 × 109 / L, hemoglobin 118 g / L, erythrocytes 3.7 × 1012 / L and platelets 81 × 109 / L. Disable rhIFNα-2b, continue to use other drugs, and add recombinant human granulocyte macrophage colony stimulating factor 75μg, 1 / d subcutaneous injection. On the fifth day of treatment, the laboratory tests were as follows: leukocyte 4.8 × 109 / L, neutrophil 3.12 × 109 / L, hemoglobin 118 g / L, erythrocyte 3.8 × 1012 / L and platelet 61 × 109 / L. RhIFNα-2b was given again and the dose was reduced to every other day. After 10 days of re-administration, the patient sustained fever, with chest tightness and vomiting. Laboratory tests: leukocytes 0.1 × 109 / L, neutrophils were not detected, platelets 20 × 109 / L, hemoglobin 92 g / L, red blood cells 3.3 × 1012 / L. Immediately disable rhIFNα-2b, given symptomatic treatment. According to clinical symptoms and bone marrow puncture test results, diagnosis of aplastic anemia. Then add human immunoglobulin and glucocorticoid treatment. Platelets on the 15th day 3.0 × 109 / L, blood cultures detected Klebsiella pneumoniae. On the 17th day, the patient suddenly had dyspnea, edema, peripheral petechia and ecchymosis. On the 19th day, the patient’s condition deteriorated and he died after being rescued.