慢性乙型肝炎患者血液学改变的流行病学调查  

Epidenmiological investigation on serologic changes in patients with chronic hepatitis B

作　　者：景晔[1] 陆光生[1] 王莉[1] 周英杰[1] 孙菁[1] 白玉[1] 李巍[1] 

机构地区：[1]北京军区天津疗养院,天津市300381

出　　处：《中华实验和临床感染病杂志（电子版）》2012年第5期58-62,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的通过调查慢性乙型肝炎患者贫血发病率及相关因素,了解其血液学发病机制及对不同类型乙型肝炎结局的影响。方法调查和分析4079例慢性乙型肝炎及乙型肝炎后肝硬化患者的年龄、性别、病情、既往病史、并发症、血常规、部分骨髓超微结构、体外祖细胞培养及血细胞形态学。结果 1990～2000年及2001～2010年慢性乙型肝炎贫血发病率分别为74.03%及60.07%;其中,女性患者高于男性,且随病情的进展贫血的发病率逐渐增高;其中以大细胞性贫血为主,占58.87%;检测结果显示4079例不同类型慢性乙型肝炎及乙型肝炎后肝硬化患者的红细胞平均体积(MCV)和红细胞宽度(RDW),均显著高于轻型乙型肝炎患者。骨髓粒细胞胞浆内发现有乙型肝炎病毒表面抗原,骨髓微环境损害,体外祖细胞减少,幼红细胞胞浆呈菊花样改变,巨核细胞呈退行性变,幼粒细胞凋亡,成熟红细胞寿命缩短,而相继出现贫血、伴白细胞减少或三系血细胞(白细胞系,红细胞系及血小板)同时减少的三种血液学改变。结论慢性乙型肝炎患者贫血的直接原因可能是HBV在骨髓血细胞内复制而逃避免疫清除,导致骨髓呈病态造血,无效红细胞生成,进而演变为慢性病变;幼稚血细胞增殖、分化和成熟障碍,血细胞随病情进展呈持续凋亡而不可逆转;而缺乏铁、叶酸和维生素B12(VB12)又是该病贫血发生的继发因素。Objective To investigate the prevalence and related factors of chronic hepatitis B patients with anemia, and explore the pathogenesis of hematology and the effect on outcome of the patients with hepatitis B. Methods Total of 4079 cases with chronic hepatitis B and liver cirrhosis after hepatitis B were investigated and their ages, sex, illness, past medical history, complications, blood, part of the bone marrow ultrastructure progenitor cell culture and blood cell morphology were analyzed. Results The incidence of anemia of patients with chronic hepatitis B during 1990 to 2000 and 2001 to 2010 were 74.03% and 60.07%, respectively. The incidence of women patients was higher than that of men, and the prevalence rate of anemia gradually increased with the disease progressing and mainly large cell anemia, accounting for 58.87%. The mean corpuscular volume （MCV） and red cell distribution width （RDW） of 4079 cases with chronic hepatitis B and liver cirrhosis were detected simultaneously, which were significantly higher than patients with light hepatitis B. Hepatitis B virus antigen was found in granulocyte, bone marrow microenvironment damaged, progenitor cells reduced, normoblast cytoplasm daisy-like changed, megakaryocytes degenerated, promyelocytic apoptosis and shortened life of mature blood cells in the bone marrow cytoplasmic after successive anemia with leukopenia, three-line while reducing blood cells. Conclusions The direct cause of anemia of chronic hepatitis B patients may be HBV escape of immune clearance in the bone marrow blood cells by the replication of hepatitis B virus. The bone marrow occured dysplasia,with the invalid blood cell production growing into chronic lesions and immature blood cell occuring proliferation, differentiation, and mature disorder. With disease progressing, blood cells occured sustained apoptosis and irreversible. Deficinecy of iron, folic acid and vitamin B12 （VB12） are secondary factors of anemia in this disease.

关 键 词：肝炎 乙型 血液学 病态造血 

分 类 号：R512.62[医药卫生—内科学]