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目的评价再生障碍性贫血(AA)合并乙型肝炎病毒(HBV)感染患者免疫抑制治疗(IST)过程中病毒活化及预防。方法回顾性分析2013年12月至2016年11月就诊于南京医科大学第一附属医院血液科收治的201例重型及非重型再生障碍性贫血(SAA/NSAA)患者接受抗胸腺细胞免疫球蛋白(ATG)联合环孢素A(CsA)或单用CsA行IST时HBV感染情况,评价治疗前后的肝功能、乙肝两对半、HBV-DNA定量和血液学疗效。结果共60例(29.8%)AA患者伴HBV感染(SAA 15例,NSAA 45例),其中HBsAg阳性12例(20.0%);HBsAg阴性48例(80.0%)。所有患者应用IST前肝功能正常、HBV-DNA定量低于检测下限。IST后,5例(8.3%)出现HBV激活,均为HBsAg阳性(含合并HBe抗原阳性1例)且未预防治疗者,抗病毒药物治疗后4例HBV-DNA控制于检测范围内。7例HBsAg阳性使用抗病毒预防未出现病毒复制。抗-HBc抗体阳性者未使用预防性抗病毒治疗,IST后无病毒激活。HBV感染组与无HBV感染组的IST治疗有效率各为43.1%和37.6%(P=0.469);HBV感染组中,使用抗HBV治疗者IST有效率为50.0%,未用者为39.5%(P=0.496)。结论 AA合并HBV感染,若HBsAg阳性者,不预防性抗病毒治疗有病毒激活风险;AA合并HBV感染不影响对IST疗效,抗HBV治疗不影响IST的疗效。
Objective To evaluate the virus activation and prevention during immunosuppressive therapy (IST) in patients with aplastic anemia (AA) and hepatitis B virus (HBV) infection. Methods A retrospective analysis of 201 patients with severe and non-severe aplastic anemia (SAA / NSAA) admitted to Department of Hematology, the First Affiliated Hospital of Nanjing Medical University from December 2013 to November 2016 was performed on an anti-thymocyte immunoglobulin ATG) combined with cyclosporin A (CsA) or CsA only IST HBV infection, evaluation of liver function before and after treatment, hepatitis B two and a half, HBV-DNA quantification and hematological efficacy. Results A total of 60 AA patients (29.8%) had HBV infection (SAA in 15 and NSAA in 45), of which 12 were HBsAg positive (20.0%) and 48 were HBsAg negative (80.0%). All patients with normal liver function before IST, HBV-DNA quantitative lower than the detection limit. After IST, HBV was activated in 5 cases (8.3%), all of which were positive for HBsAg (1 with positive HBe antigen) and were not treated. HBV-DNA was detected in 4 cases after antiviral treatment. Seven cases of HBsAg-positive use of antiviral prevention did not appear virus replication. Anti-HBc antibody-positive patients were not treated with prophylactic antiviral therapy and virus-free after IST. In HBV-infected group, the effective rate of IST in HBV-infected group was 43.1% and in 37.6% (HBV-infected group) was 50.0% and that in un-HBV-infected group was 39.5% P = 0.496). Conclusions AA combined HBV infection, if HBsAg-positive, did not prevent the risk of virus activation of antiviral therapy; AA combined with HBV infection does not affect the efficacy of IST, anti-HBV treatment does not affect the efficacy of IST.