儿童肝炎相关再生障碍性贫血临床特征分析

doi:10.3969/j.issn.1006-5725.2025.01.014

Abstract

Abstract:

Objective To investigate the clinical characteristics of hepatitis?associated aplastic anemia （HAAA） in pediatric patients. Methods A retrospective study was conducted on 212 children with aplastic anemia （AA） who were hospitalized at Henan Children's Hospital from September 2014 to February 2023. The patients were categorized into two groups based on etiology： the HAAA group and the non?HAAA group. The study group consisted of 23 patients in the HAAA group， while a control group of 115 children without HAAA was matched in a 1∶5 ratio based on age， sex， and severity of aplastic anemia. The clinical characteristics， treatment regimens， and outcomes of the 23 patients with HAAA were analyzed and compared with those of the control group comprising 115 patients. Results Among the 23 children with HAAA， there were 11 males and 12 females， with a median age of 6 years and 3 months （ranging from 1 year and 4 months to 12 years old）. The onset of aplastic anemia in all HAAA children occurred after the initial presentation of acute hepatitis. Following gradual improvement in liver function， peripheral blood images showed a progressive decline by two or three lines， including platelets. Among these cases， very severe aplastic anemia was observed in 14 patients （60.9%）， severe aplastic anemia in 7 patients （30.4%）， and non?severe aplastic anemia in 2 patients （8.7%）. The median interval between hepatitis onset and diagnosis of aplastic anemia was found to be 56 days （range：10 ~ 157 days）. All 23 pediatric patients with HAAA presented with acute icteric hepatitis， accounting for 100% of the cohort. One patient （4.3%） was genetically diagnosed with X?linked lymphoproliferative disease type 2， while liver biopsy revealed drug?induced hepatitis/chemical liver injury in five patients （21.7%）. Compared to the control group， HAAA patients exhibited significantly lower levels of CD4⁺ cells ［（1.2 ± 0.3） vs. （1.5 ± 0.1）］ and CD4⁺/CD8⁺ ratios ［（-0.2 ± 0.4） vs. （0.1 ± 0.2）］（P < 0.05）. Three patients received immunosuppressive therapy （IST）， 18 underwent hematopoietic stem cell transplantation （HSCT）， and two non?severe cases were treated with methylprednisolone sodium succinate and compound Zapoan pill； all patients survived. Conclusions Children with HAAA present a critical condition and exhibit a poor prognosis， predominantly manifesting as severe or extremely severe aplastic anemia during the recovery phase of hepatitis. Reduction in CD4⁺ cell count and inversion of CD4⁺/CD8⁺ ratio may serve as early warning indicators for HAAA. Effective improvement in prognosis can be achieved through immunosuppressive therapy and hematopoietic stem cell transplantation.

Key words: anemia, aplastic, hepatitis, children, clinical features

CLC Number:

R725

Bingjie QUAN,Yijing LIU,Xiaoqin LI,Fang ZHOU. Clinical features of hepatitisassociatedaplastic anemia in children[J]. The Journal of Practical Medicine, 2025, 41(1): 84-89.

Figures/Tables 4

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References 27

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项目	肝炎发病时	HAAA发病时	t值	P值
ALT/（U/L）	10.5 ± 0.8	7.2 ± 0.2	5.570	< 0.001
AST/（U/L）	10.3 ± 1.0	7.2 ± 1.8	4.974	< 0.001
TBil/（μmol/L）	7.3 ± 0.9	4.6 ± 1.4	4.696	< 0.001
DBil/（μmol/L）	5.2 ± 1.1	3.2 ± 1.3	4.632	< 0.001
TBA/（μmol/L）	7.7 ± 0.7	4.4 ± 1.5	5.486	< 0.001
GGT/（U/L）	7.2 ± 0.9	6.2 ± 1.6	1.400	0.174

项目	肝炎发病时	HAAA发病时	t值	P值
白细胞/（×10⁹/L）	32.2 ± 0.4	27.5 ± 5.6	10.825	< 0.001
红细胞/（×10¹²/L）	32.1 ± 0.1	31.3 ± 0.3	12.014	< 0.001
血红蛋白/（g/L）	36.8 ± 0.1	36.1 ± 0.3	10.132	< 0.001
血小板/（×10⁹/L）	37.3 ± 0.5	32.7 ± 1.2	10.077	< 0.001
中性粒细胞计数/（×10⁹/L）	31.8 ± 0.7	22.5 ± 7.5	8.390	< 0.001
网织红细胞计数/（×10⁹/L）	35.8 ± 0.9	33.1 ± 1.1	4.793	< 0.001

项目	肝炎发病时	HAAA发病时	t值	P值
T细胞（CD3⁺）/%	5.9 ± 0.4	5.8 ± 0.5	0.606	0.550
T8细胞（CD8⁺）/%	5.2 ± 0.5	5.2 ± 0.7	-0.249	0.805
T4细胞（CD4⁺）/%	3.2 ± 1.7	3.5 ± 0.8	0.350	0.730
CD4/CD8	1.3 ± 0.2	1.3 ± 0.2	0.015	0.988
NK细胞（CD16⁺56⁺）/%	3.4 ± 0.8	2.9 ± 1.5	0.341	0.736
B细胞（CD19⁺）/%	3.7 ± 1.6	4.2 ± 1.8	-1.156	0.259

项目	HAAA组（n = 23）	非HAAA组（n = 115）	t/χ²/Z值	P值
年龄（x ± s）/岁	6.6 ± 3.5	7.0 ± 3.7	0.502	0.616
性别/［例（%）］			1.001	0.317
男	11	68
女	12	47
实验室检查
TBil（x ± s）/（μmol/L）	1.4 ± 0.5	0.9 ± 0.2	-4.077	< 0.001
DBil（x ± s）/（μmol/L）	1.0 ± 0.9	0.2 ± 0.3	-3.949	0.001
ALT（x ± s）/（U/L）	1.4 ± 0.7	1.3 ± 0.3	-0.451	0.656
AST（x ± s）/（U/L）	1.5 ± 0.7	1.4 ± 0.2	-0.328	0.746
WBC（?x ± s）/（×10⁹/L）	0.2 ± 0.6	0.5 ± 0.3	1.961	0.062
NEUT（?x ± s）/（×10⁹/L）	1.5 ± 0.4	1.3 ± 0.3	-1.447	0.150
CD4⁺/CD8⁺（x ± s）	-0.2 ± 0.4	0.1 ± 0.2	4.473	< 0.001
T细胞（CD3⁺）（x ± s）/%	1.7 ± 0.1	1.8 ± 0.1	2.124	0.051
T8细胞（CD8⁺）（x ± s）/%	1.5 ± 0.2	1.4 ± 0.1	-2.101	0.060
T4细胞（CD4⁺）（x ± s）/%	1.2 ± 0.3	1.5 ± 0.1	4.594	< 0.001
NK细胞（CD16⁺56⁺）（x ± s）/%	0.8 ± 0.4	0.8 ± 0.3	-1.034	0.303
B细胞（CD19⁺）（x ± s）/%	1.2 ± 0.4	1.2 ± 0.2	0.082	0.935

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Clinical features of hepatitisassociatedaplastic anemia in children

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