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目的探讨异基因造血干细胞移植患者乙型肝炎的临床表现、病理、自然史。方法总结合并HBV感染的异基因造血干细胞移植患者10例,其乙型肝炎发病时临床和肝组织病理资料。血清丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(GGT)采用速率法,血清总胆红素(TBIL)采用终点比色法检测;乙型肝炎病毒血清标志物采用酶免疫测定(EIA),HBVDNA定量测定采用聚合酶链反应(PCR)试剂盒。其中8例进行了肝组织活检。结果(1)5例患者有慢性乙型肝炎病史,5例患者有乙型肝炎家族史,4例患者有HBV暴露史。(2)移植前10例患者肝功能指标包括ALT、TBIL、GGT均正常,而在乙型肝炎发作时上述指标均显著升高。(3)移植前受者的乙型肝炎免疫性检测为1例患者HBsAg阳性、HBeAg阳性、抗-HBc阳性;1例患者抗-HBs阳性、抗-HBc阳性;3例患者仅抗-HBc阳性;4例患者HBsAg阳性、抗-HBe阳性、抗-HBc阳性;1例患者仅抗-HBs阳性。(4)3例患者肝脏病理学诊断为纤维化瘀胆性肝炎,4例患者诊断为慢性乙型肝炎,1例患者诊断为急性乙型肝炎。(5)在随访终点时,5例患者死于重型肝炎,1例患者死于肺炎,3例患者发展为慢性乙型肝炎,1例患者痊愈。结论(1)HSCT术后乙型肝炎患者常有乙型肝炎病史、乙型肝炎家族史或HBV暴露史。(2)HSCT乙型肝炎患者的临床特点、病理、自然史不同于正常免疫状态的乙型肝炎患者。
Objective To investigate the clinical manifestations, pathology and natural history of hepatitis B in patients with allogeneic hematopoietic stem cell transplantation. Methods Ten patients with HBV-infected allogeneic hematopoietic stem cell transplantation were enrolled. The clinical and pathological data of hepatitis B were collected. Serum alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT) using rate method, serum total bilirubin (TBIL) using end-point colorimetric detection; Hepatitis B virus serum markers using enzyme immunoassay Assay (EIA), HBVDNA quantitative determination using polymerase chain reaction (PCR) kit. Eight of them underwent liver biopsy. Results (1) 5 patients had a history of chronic hepatitis B, 5 patients had a family history of hepatitis B, and 4 patients had a history of HBV exposure. (2) The indexes of liver function including ALT, TBIL and GGT were all normal in the 10 patients before transplantation, while the above indexes were significantly increased in the attack of hepatitis B. (3) HBsAg positive, HBeAg positive and anti-HBc positive in 1 patient before transplantation; 1 anti-HBs positive and anti-HBc positive; 3 patients only anti-HBc positive ; 4 patients were HBsAg positive, anti-HBe positive, anti-HBc positive; 1 patient anti-HBs positive only. (4) Liver biopsy was diagnosed as fibrosis eclampsia in 3 patients, chronic hepatitis B in 4 patients and acute hepatitis B in 1 patient. (5) At the end of follow-up, 5 patients died of severe hepatitis, 1 died of pneumonia, 3 developed chronic hepatitis B, and 1 recovered. Conclusions (1) Patients with hepatitis B after HSCT often have a history of hepatitis B, a family history of hepatitis B or a history of HBV exposure. (2) The clinical features, pathology and natural history of patients with HSCT hepatitis B are different from those of patients with normal immune status.