临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (4): 256-.doi: 10.3969/j.issn.1000-3606.2017.04.004

• 营养消化系统专栏 • 上一篇    下一篇

儿童肝炎相关再生障碍性贫血5 例分析

李向, 赵晓明, 盛光耀   

  1. 郑州大学第一附属医院儿科(河南郑州 450052)
  • 收稿日期:2017-04-15 出版日期:2017-04-15 发布日期:2017-04-15
  • 通讯作者: 盛光耀 E-mail:shenggy 2959@163 .com

Analysis of hepatitis associated aplastic anemia in 5 children

 LI Xiang, ZHAO Xiaoming, SHENG Guangyao   

  1. Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052 , Henan ,China
  • Received:2017-04-15 Online:2017-04-15 Published:2017-04-15

摘要: 目的 探讨儿童肝炎相关再生障碍性贫血(HAAA)的临床特点、治疗及预后。方法 回顾分析5例HAAA患 儿的临床资料。结果 5例患儿,男4例、女1例,中位年龄为10岁(7~13岁);5例患儿急性肝炎期间甲、乙、丙、戊肝炎病 毒检测均为阴性,其中2例行微小病毒B19抗体、EB病毒检测均为阴性; T淋巴细胞亚群示CD4+ T细胞比例、CD4+/CD8+ 比值降低,CD8+ T细胞比例升高。 3例以抗胸腺细胞球蛋白联合环孢素免疫抑制治疗2例完全缓解, 1例死于肺部真菌感 染; 1例单用环孢素免疫抑制治疗,部分缓解; 1例放弃治疗后失访。结论 儿童HAAA可由病毒血清学阴性的肝炎引起, 存在T淋巴细胞免疫紊乱,免疫抑制治疗有效。

Abstract:  Objective To explore the clinical feature, treatment and prognosis of hepatitis associated aplastic anemia (HAAA) in children. Method The clinical data of 5 children with HAAA were retrospectively analyzed. Results There were 5 patients (4 males and 1 female) with median age of 10 years (7~13 years ). The detection of hepatitis A, B, C, and E were all negative in these 5 children during their acute hepatitis period. In 2 children, parvovirus B19 antibody and EB virus were negative and the proportion of CD4+T cells and the ratio of CD4+/CD8+ were decreased, and the proportion of CD8+T cells was increased by T-lymphocyte subsets analysis. Three children were treated with anti-thymocyte globulin combined with cyclosporine, 2 of whom achieved complete remission and 1 died of pulmonary fungal infection. One child was treated with cyclosporine only and achieved partial remission. One child lost follow-up after giving up treatment. Conclusion HAAA in children can be caused by viral seronegative hepatitis, and usually has T lymphocyte immune disorders.  Immunosuppressive therapy is effective.