急性乙型肝炎合并一过性再生障碍性贫血1例报告

张玉; 田雨; 董美丽; 张瑞华; 王阳; 温晓玉

doi:10.3969/j.issn.1001-5256.2023.03.021

急性乙型肝炎合并一过性再生障碍性贫血1例报告

DOI: 10.3969/j.issn.1001-5256.2023.03.021

吉林大学第一医院肝胆胰内科，长春 130021

基金项目:

吉林省科技计划项目基金 (20190201065JC)

伦理学声明：本例报告已获得患者知情同意。

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：张玉负责资料分析，撰写论文；田雨、董美丽、张瑞华参与收集并分析数据；王阳负责撰写文章并修改文章；温晓玉指导撰写文章并最后定稿。

详细信息

通信作者:
温晓玉，xywen@jlu.edu.cn(ORCID: 0000-0003-2109-1557)

计量
- 文章访问数: 401
- HTML全文浏览量: 142
- PDF下载量: 104
- 被引次数: 0
出版历程
- 收稿日期: 2022-08-03
- 录用日期: 2022-09-20
- 出版日期: 2023-03-20

Transient aplastic anemia associated with acute hepatitis B: A case report

Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, China

Research funding:

Foundation of Science and Technology Commission of Jilin Province (20190201065JC)

More Information

Corresponding author: WEN Xiaoyu, xywen@jlu.edu.cn (ORCID: 0000-0003-2109-1557)

摘要

- 乙型肝炎, 慢性 /
- 贫血, 再生障碍性 /
- 胆汁淤积, 肝内
- Hepatitis B, Chronic /
- Anemia, Aplastic /
- Cholestasis, Intrahepatic

HTML全文

图 1 住院期间WBC、RBC、PLT和Hb变化

Figure 1. Time course of WBC、RBC、PLT and Hb while in hospital

下载: 全尺寸图片幻灯片

图 2 住院期间骨髓穿刺涂片(×1000)

注：a、b，髂骨骨髓增生重度降低，粒细胞缺乏，巨核细胞少，吞噬细胞易见；c、d，胸骨骨髓增生活跃，粒、红两系比例大致正常，粒细胞颗粒明显增多，血小板成堆可见。

Figure 2. Bone marrow aspirate smear while in hospital(×1000)

下载: 全尺寸图片幻灯片

表 1 住院期间HBV血清标志物及HBV DNA变化

Table 1. Time course of serum markers of HBV and HBV DNA while in hospital

时间	HBsAg (IU/mL)	抗-HBs (mIU/mL)	HBeAg (COI)	抗-HBe (COI)	抗-HBc (COI)	HBV DNA (IU/mL)
2021.10.13	＜0.050	23.14	0.121	0.01	0.01	151
2021.10.24	0	-	-	-	-	197
2021.11.01	0	-	-	-	-	53
2021.11.10	0	244.58	0.391	0.400	5.490	＜50

下载: 导出CSV

参考文献(17)

[1]	KILLICK SB, BOWN N, CAVENAGH J, et al. Guidelines for the diagnosis and management of adult aplastic anaemia[J]. Br J Haematol, 2016, 172(2): 187-207. DOI: 10.1111/bjh.13853.
[2]	WANG L, LIU H. Pathogenesis of aplastic anemia[J]. Hematology, 2019, 24(1): 559-566. DOI: 10.1080/16078454.2019.1642548.
[3]	BROWN KE, TISDALE J, BARRETT AJ, et al. Hepatitis-associated aplastic anemia[J]. N Engl J Med, 1997, 336(15): 1059-1064. DOI: 10.1056/NEJM199704103361504.
[4]	MORI T, ONISHI Y, OZAWA Y, et al. Outcome of allogeneic hematopoietic stem cell transplantation in adult patients with hepatitis-associated aplastic anemia[J]. Int J Hematol, 2019, 109(6): 711-717. DOI: 10.1007/s12185-019-02644-8.
[5]	ZAHNG YT, YE D, LI XY, et al. Baseline HBsAg quantitative level, dynamic changes and clinical signifi-cance of adult acute hepatitis B[J]. China Mod Doct, 2021, 59(12): 1-4, 15, 193. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202112001.htm 张雨婷, 叶栋, 李欣予, 等. 成人急性乙型肝炎基线HBsAg定量水平、动态变化及临床意义[J]. 中国现代医生, 2021, 59(12): 1-4, 15, 193. https://www.cnki.com.cn/Article/CJFDTOTAL-ZDYS202112001.htm
[6]	Red Cell Disease (Anemia) Group, Hematology Branch, Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of aplastic anemia (2017)[J]. Chin J Hematol, 2017, 38(1): 1-5. DOI: 10.3760/cma.j.issn.0253-2727.2017.01.001. 中华医学会血液学分会红细胞疾病(贫血)学组. 再生障碍性贫血诊断与治疗中国专家共识(2017年版)[J]. 中华血液学杂志, 2017, 38(1): 1-5. DOI: 10.3760/cma.j.issn.0253-2727.2017.01.001.
[7]	HENDREN N, MOORE J, HOFMANN S, et al. Resolution of acute hepatitis B-associated aplastic anaemia with antiviral therapy[J]. BMJ Case Rep, 2017, 2017: bcr2017221503. DOI: 10.1136/bcr-2017-221503.
[8]	BOZKAYA H, YURDAYDIN C, TÖRVNER M, et al. Remission of severe aplastic anemia associated with hepatitis B virus infection after viral clearance: potential role of lamivudine[J]. Dig Dis Sci, 2002, 47(8): 1782-1785. DOI: 10.1023/a:1016444611997.
[9]	IKEDA T, MORIMOTO A, NAKAMURA S, et al. A marked decrease in CD4-positive lymphocytes at the onset of hepatitis in a patient with hepatitis-associated aplastic anemia[J]. J Pediatr Hematol Oncol, 2012, 34(5): 375-377. DOI: 10.1097/MPH.0b013e31822bf699.
[10]	AKRAM Z, AHMED P, KAJIGAYA S, et al. Epidemiological, clinical and genetic characterization of aplastic anemia patients in Pakistan[J]. Ann Hematol, 2019, 98(2): 301-312. DOI: 10.1007/s00277-018-3542-z.
[11]	BÄR C, POVEDANO JM, SERRANO R, et al. Telomerase gene therapy rescues telomere length, bone marrow aplasia, and survival in mice with aplastic anemia[J]. Blood, 2016, 127(14): 1770-1779. DOI: 10.1182/blood-2015-08-667485.
[12]	SHI YM, LAN YH, SHAN L, et al. The relationship between of hematopoietic stem cells and hepatitis B virus infection[J]. J Clin Hepatol, 2010, 26(4): 377-380. DOI: 10.3969/j.issn.1001-5256.2010.04.012. 石雁梅, 兰英华, 单蕾, 等. 乙型肝炎病毒感染时的骨髓造血干细胞[J]. 临床肝胆病杂志, 2010, 26(4): 377-380. DOI: 10.3969/j.issn.1001-5256.2010.04.012.
[13]	RULE JA, HYNAN LS, ATTAR N, et al. Procalcitonin identifies cell injury, not bacterial infection, in acute liver failure[J]. PLoS One, 2015, 10(9): e0138566. DOI: 10.1371/journal.pone.0138566.
[14]	ZHANG Q, RAOOF M, CHEN Y, et al. Circulating mitochondrial DAMPs cause inflammatory responses to injury[J]. Nature, 2010, 464(7285): 104-107. DOI: 10.1038/nature08780.
[15]	ROH JS, SOHN DH. Damage-associated molecular patterns in inflammatory diseases[J]. Immune Netw, 2018, 18(4): e27. DOI: 10.4110/in.2018.18.e27.
[16]	MATWIYOFF GN, PRAHL JD, MILLER RJ, et al. Immune regulation of procalcitonin: a biomarker and mediator of infection[J]. Inflamm Res, 2012, 61(5): 401-409. DOI: 10.1007/s00011-012-0439-5.
[17]	LAI ZX, WANG F, WANG S, et al. Acute-on-chronic liver failure with severe bone marrow suppression: A case report[J]. J Clin Hepatol, 2019, 35(9): 2050-2053. DOI: 10.3969/j.issn.1001-5256.2019.09.034. 赖长祥, 王方, 王松, 等. 慢加急性肝衰竭合并严重骨髓抑制1例报告[J]. 临床肝胆病杂志, 2019, 35(9): 2050-2053. DOI: 10.3969/j.issn.1001-5256.2019.09.034.