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目的 探讨慢性乙型肝炎病毒(HBV)感染并发重型再生障碍性贫血(SAA)的临床特征。方法 观察1991-01~2003-12中国医学科学院血液学研究所诊治的737例SAA患者中慢性乙型病毒性肝炎(慢性乙型肝炎)并发SAA患者(21例,Ⅰ组)所占比例,并采用病例对照方法探讨慢性HBV感染[慢性乙型肝炎和HBV抗体阳性组(23例,Ⅱ组) ]并发SAA与SAA对照组(42例,Ⅲ组)在临床表现、实验室特征及疗效和预后方面的异同。结果 (1)慢性乙型肝炎并发SAA占同期SAA的比例为2. 8%。(2) 3组患者治疗前临床特征差异无显著性。(3)治疗后Ⅰ组患者血象、骨髓象恢复晚于Ⅱ、Ⅲ组。( 4 )Ⅰ、Ⅲ组患者CD+8 细胞百分比明显高于Ⅱ组(P<0 .05,P<0 .01)。(5)3组患者3年生存率差异无显著性。结论 慢性乙型肝炎合并SAA患者经免疫抑制治疗后造血功能恢复较慢;SAA合并HBV抗体阳性者T亚群异常较轻;慢性HBV感染未显著影响SAA患者的预后。
Objective To investigate the clinical characteristics of chronic hepatitis B virus (HBV) infection complicated with severe aplastic anemia (SAA). Methods The proportion of patients with chronic hepatitis B (chronic hepatitis B) complicated with SAA (21 cases, group Ⅰ) in 737 SAA patients diagnosed and treated by Institute of Hematology, Chinese Academy of Medical Sciences from January 1991 to December 2003 was observed. A case-control study was conducted to investigate the clinical manifestations, laboratory characteristics and efficacy and prognosis of patients with chronic HBV infection [chronic hepatitis B and HBV antibody-positive group (23 patients, group Ⅱ)] with SAA and SAA control group (42 patients, Similarities and differences in aspects. Results (1) The proportion of chronic hepatitis B complicated with SAA in the same period was 2.8%. (2) There was no significant difference in the clinical features between the three groups before treatment. (3) After treatment, the blood and bone marrow of patients in group Ⅰ recovered later than those in group Ⅱ and Ⅲ. (4) The percentage of CD + 8 cells in group Ⅰ and Ⅲ was significantly higher than that in group Ⅱ (P <0.05, P <0.01). (5) There was no significant difference in 3-year survival rate between the 3 groups. Conclusion The recovery of hematopoietic function in patients with chronic hepatitis B and SAA is slower than that in patients with SAA. The subgroup T of SAA combined with HBV antibody is abnormally mild. The chronic HBV infection has no significant effect on the prognosis of patients with SAA.