儿童肝炎相关再生障碍性贫血2例及文献回顾

doi:10.3969/j.issn.1004-583X.2024.07.010

摘要/Abstract

摘要：

目的分析儿童肝炎相关再生障碍性贫血(HAAA)的临床表现、相关病因及治疗方法。方法回顾性分析2例儿童肝炎相关再生障碍性贫血的临床资料。结果 2例患儿均为男性,完善相关肝炎病毒、梅毒螺旋体、艾滋病病毒、EBV、TORCH及细小病毒B19 检测,结果均阴性。病例1用环孢素+泼尼松治疗,部分缓解。病例2行异基因造血干细胞移植术(哥供弟),完全缓解。结论儿童HAAA多发生于急性肝炎恢复期,病因不明;治疗以免疫抑制剂为主。

关键词: 肝炎, 贫血, 再生障碍性, 儿童

Abstract:

Objective To analyze the clinical manifestation, etiology and treatment of hepatitis associated aplastic anemia (HAAA) in children. Methods Clinical data of two children with HAAA were retrospectively analyzed. Results The two children were all male, with an average age of 5 years and 11 months. Hepatitis A, B and C virus, treponema pallidum, acquired immunodeficiency syndrome (AIDS) virus, Epstein-Barr virus (EBV), TORCH (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex virus I and II) and parvovirus B19 were all negative. Case 1 treated with cyclosporine prednisone immunosuppression was partially relieved. Case 2 underwent allogeneic hematopoietic stem cell transplantation (brother donor brother) was completely relieved. Conclusion HAAA in children often occurs in the recovery period of acute hepatitis, with undetermined etiology. The treatment is mainly immunosuppressive.

Key words: hepatitis, anemia, aplastic, children

中图分类号:

伍秋频, 严士为, 何筱胤, 李云, 陆丽菊, 吴怡. 儿童肝炎相关再生障碍性贫血2例及文献回顾[J]. 临床荟萃, 2024, 39(7): 640-643.

Wu Qiupin, Yan Shiwei, He Xiaoyin, Li Yun, LU Liju, Wu Yi. Analysis of hepatitis associated aplastic anemia in children[J]. Clinical Focus, 2024, 39(7): 640-643.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.07.010

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I7/640

图/表 3

参考文献 24

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病例	病程	DBil(μmol/L)	ALT(U/L)	AST(U/L)	TBA(μmol/L)	GGT(U/L)
1	入院时	231.7	3475	2275	346.7	94
	确诊时	3.73	119	75	6.7	41
2	入院时	131.02	2243	2262	294.1	150
	确诊时	8.21	280	105	60.6	50

病例	病程	DBil(μmol/L)	ALT(U/L)	AST(U/L)	TBA(μmol/L)	GGT(U/L)
1	入院时	231.7	3475	2275	346.7	94
	确诊时	3.73	119	75	6.7	41
2	入院时	131.02	2243	2262	294.1	150
	确诊时	8.21	280	105	60.6	50

病例	病程	WBC(×10⁹/L)	Neu(×10⁹/L)	RBC(×10¹²/L)	HGB(g/L)	PLT(×10⁹/L)	骨髓增生程度	分型
1	入院时	0.5	0.23	3.5	97	248
	确诊时	1.8	0.23	3.4	98	55	15%	重型
2	入院时	4.7	3.56	4.2	118	154
	确诊时	3.0	0.68	3.8	120	18	10%	重型

病例	病程	WBC(×10⁹/L)	Neu(×10⁹/L)	RBC(×10¹²/L)	HGB(g/L)	PLT(×10⁹/L)	骨髓增生程度	分型
1	入院时	0.5	0.23	3.5	97	248
	确诊时	1.8	0.23	3.4	98	55	15%	重型
2	入院时	4.7	3.56	4.2	118	154
	确诊时	3.0	0.68	3.8	120	18	10%	重型

病例	CD3+ (65%~79%)	CD3+CD4+ (34%~52%)	CD3+CD8+ (21%~39%)	CD4/CD8 (0.53%~2.31%)	CD3-CD19+ (9.02%~14.1%)	CD56+CD16+ (10%~19.78%)
1	80.69	10.97	60.56	0.18	18.53	2.57
2	88.95	56.21	26.06	2.16	7.16	2.56