中国实用内科杂志2017，Vol.37Issue(5)：460-464,5.DOI:10.19538/j.nk2017050125
再生障碍性贫血合并乙型肝炎病毒感染60例免疫抑制治疗疗效分析
Reactivation of hepatitis B virus infection in aplastic anemia patients treated by immunosuppressive therapy
摘要
Abstract
Objective To investigate the risk of hepatitis B virus(HBV) reactivation in patients with aplastic anemia (AA) complicated with HBV infection and its preventive measure during immunosuppressive therapy (IST).Methods The clinical infection data of 201 cases with severe and non-severe aplastic anemia (SAA/NSAA) received cyclosporine (CsA) alone or combined with anti-thymocyte globulin (ATG) in the Department of Hematology,the First Affiliated Hospital of Nanjing Medical University from December 2013 to November 2016 were retrospectively analyzed.The clinical effects and laboratory examination index were evaluated.Result A total of 60 cases (29.8％) with AA complicated with HBV infection (SAA 15 cases,NSAA 45 cases),12 cases (20％) were HBsAg positive,and 48 cases (80％) with HBc-Ab but HBsAg were negative.Before IST,all patients had normal liver function,and HBV-DNA was lower than the detection limit.After IST,5 (8.3％) of 12 patients with HBsAg positive (including one with HBeAg) suffered virus reactivation,since without prophylactic antiviral therapy.Quantification of HBV-DNA and the liver function returned to normal level in 4 of these 5 patients after antiviral medicine was administered.No virus reactivation happened in the remaining 7 patients received prophylactic antiviral therapy.No virus reactivation happened in other 48 patients with HBc-Ab but negative HBsAg,although no prophylactic antiviral therapy was used.The response rate of IST in HBV infection group and non-HBV infection group was 43.1％ and 37.6％ (P=0.469) respectively,the response rate of IST about antiviral therapy group were similar with non-antiviral therapy group,there was no significant difference (50.0％ vs.39.5％,P=0.496).Conclusion AA patients with HBV infection,higher risk of virus reactivation was observed in patients with positive HBsAg and non prophylactic antiviral therapy,the HBV infection and anti-HBV therapy had no influence on the efficacy of IST.关键词
贫血/再生障碍性/治疗/免疫抑制/乙型病毒性肝炎Key words
aplastic anemia/immunosuppressive therapy/hepatitis B reactivation/prophylactic antiviral therapy分类
医药卫生引用本文复制引用
王素丽,王莉,张建富,乔纯,吴雨洁,吴雪梅,陆星羽,李建勇,何广胜,沈文怡,卢瑞南,朱雨,朱华渊,缪扣荣,洪鸣,王帅..再生障碍性贫血合并乙型肝炎病毒感染60例免疫抑制治疗疗效分析[J].中国实用内科杂志,2017,37(5):460-464,5.基金项目
江苏省卫生厅面上项目(Z201402) （Z201402）
国家自然科学基金(81400079) （81400079）
