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摘要: 目的:分析我地区免疫性血小板减少症(ITP)患者的乙肝病毒感染状态与ITP临床相关性,提供合理的治疗方案。方法:收集2016-08-2019-08在我院住院的ITP患者93例,对其中64例患者给予糖皮质激素或联合免疫球蛋白治疗,分析所有患者的临床特征,并对64例糖皮质激素治疗患者的疗效影响因素进行分析。结果:我地区ITP患者乙肝核心抗体阳性率高于同期住院患者(46.2% vs 18.7%,P=0.004);对于疗效和血小板恢复时间,乙肝感染状态是独立影响因素(P<0.05)。结论:我地区ITP患者存在乙肝隐匿性感染可能,对于乙肝核心抗体阳性的ITP患者糖皮质激素疗效不佳,可尽早应用血小板生成素二线治疗。Abstract: Objective: To analyze the correlation between hepatitis B virus infection and immune thrombocytopenia (ITP),and to provide reasonable treatment options.Method: A total of 93 patients diagnosed with ITP hospitalized in our hospital from August 2016 to August 2019 were collected.Sixty-four patients were treated with glucocorticoid alone,or glucocorticoid combined with immunoglobulin.The clinical characteristics and risk factors of all the patients,including those treated with glucocorticoids were identified.Result: The positive rate for hepatitis B core antibody in ITP patients was significantly higher than that in hospitalized patients during the same period (46.2% vs 18.7%,P=0.004).The hepatitis B core antibody positivity was the only independent risk factor for the outcome and platelet recovery time (P<0.05).Conclusion: Occult hepatitis B virus infection may exist in ITP patients.Glucocorticoid treatment is not effective for ITP patients with hepatitis B core antibody positivity,and second-line treatment with thrombopoietin might be administrated as soon as possible.
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[1] 张小平,吴要功,杨迪,等.57例免疫性血小板减少症临床分析[J].临床血液学杂志,2019,32(3):190-196.
[2] Wei Y,Ji XB,Wang YW,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:a prospective multicenter randomized trial[J].Blood,2016,127:296-302.
[3] 侯明,秦平.成人原发免疫性血小板减少症诊治的中国专家共识(2016版)解读[J].临床血液学杂志,2016,29(7):523-527.
[4] 王凯,高伟波,朱继红.血栓性血小板减少性紫癜的研究进展[J].临床急诊杂志,2018,19(9):593-598.
[5] 石茂静,高伟波,朱继红.肝素诱导性血小板减少症的研究进展[J].临床急诊杂志,2018,19(9):599-606.
[6] 李华,陈旭艳.乙型肝炎病毒感染与常见血液病发生的相关性分析[J].中华临床医师杂志(电子版),2016,10(20):3095-3099.
[7] Kleinstern G,Seir RA,Perlman R,et al.Associations between B-cell non-Hodgkin lymphoma and exposure,persistence and immune response to Hepatitis B[J].Haematologica,2016,101:e303-e305.
[8] 竺枫,王宏强,杨序春.海岛地区合并HBV感染的非霍奇金淋巴瘤临床研究[J].临床血液学杂志,2019,32(3):210-212.
[9] 卢俊,柴忆欢.儿童免疫性血小板减少性紫癜发病因素分析[J].苏州大学学报(医学版),2005,25(1):131-132.
[10] Chen P,Yu C,Ruan B,et al.Prevalence of hepatitis B in insular regions of southeast China:a community-based study[J].PLoS One,2013,8:e56444.
[11] 陈平.实施乙型肝炎疫苗免疫20年后中国东南部海岛地区乙肝血清和分子流行病学研究[D].杭州:浙江大学,2013.
[12] 中华预防医学会肿瘤预防与控制专业委员会感染相关肿瘤防控学组,中华预防医学会慢病预防与控制分会,中华预防医学会健康传播分会,等.中国肝癌一级预防专家共识(2018)[J].中华预防医学杂志,2019,53(1):36-44.
[13] 刘甲野,吕静静,颜丙玉,等.乙型肝炎病毒核心抗体单项阳性及健康的成年人乙肝疫苗免疫效果配对比较研究[J].中华流行病学杂志,2014,35(10):1091-1094.
[14] 童汝雁,金皎,黄璟,等.儿童免疫性血小板减少症预后相关因素[J].中华实用儿科临床杂志,2019,34(11):837-841.
[15] Wei Y,Ji XB,Wang YW,et al.High-dose dexamethasone vs prednisone for treatment of adult immune thrombocytopenia:a prospective multicenter randomized trial[J].Blood,2016,127:296-302;quiz 370.
[16] 中华医学会感染病学分会,中华医学会肝病学分会.慢性乙型肝炎防治指南(2019年版)[J].中华临床感染病杂志,12(6):401-428.
[17] 陈骋,李灼日,周开伦,等.隐匿性乙型肝炎病毒感染在隐源性肝癌发生中的作用[J].中华肝胆外科杂志,2017,23(8):513-516.
[18] 李晓峰,金芳,钱福初,等.乙型肝炎病毒血清标志物单独核心抗体阳性者中乙型肝炎病毒隐匿性感染的分子特性[J].中国卫生检验杂志,2020,30(5):578-580,583.
[19] 朱萍,路毓峰,王丽,等.血清抗-HBc定量与肝脏组织炎症程度的相关性研究[J].现代中西医结合杂志,2019,28(30):3355-3358.
[20] 陈鹄,肖建华.乙型肝炎病毒与特发性血小板减少性紫癜的相关性研究[J].南华大学学报(医学版),2009,37(6):690-692.
[21] 武幸福,王振林,陈立侠.干扰素治疗肝炎病毒相关性血小板减少症的临床研究[J].世界最新医学信息文摘,2015,15(71):14+11.
[22] Miller JB,Figueroa EJ,Haug RM,et al.Thrombocytopenia in chronic liver disease and the role of thrombopoietin agonists[J].Gastroenterol Hepatol (N Y),2019,15:326-332.
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