乙肝病毒再激活致Rh血型阴性患者肝功能衰竭1例  

A Case of an Rh-negative Patient with Liver Failure Caused by Reactivation of Hepatitis B Virus

作　　者：尼亚孜艾力·萨伊提 全斌[1] 李倩[1] Niyaziaili Sayiti;Quan Bin;Li Qian(The First Affiliated Hospital of Wannan Medical College,Wuhu 241001 China)

机构地区：[1]皖南医学院弋矶山医院,安徽芜湖241001

出　　处：《锦州医科大学学报》2023年第2期90-93,共4页Journal of Jinzhou Medical University

基　　金：2020年安徽省高等学校省级质量工程项目教学研究项目,项目编号:2020jyxm2118;2021年度皖南医学院中青年科研基金项目,项目编号:WK2021F60。

摘　　要：糖皮质激素是神经和免疫系统介质,临床上用于治疗过敏、自身免疫及慢性炎症性疾病的一线药物。高剂量长期服用糖皮质激素会出现激素引起的免疫抑制、高血糖、继发性感染以及骨质疏松症等副作用。然而,糖皮质激素引起的乙型肝炎病毒再激活的案例少见。我们报道一例乙型病毒性肝炎病史,Rh阴性血型患者因膜性肾病口服糖皮质激素治疗1年后出现纳差、腹胀以及黄疸等肝功能衰退的表现。考虑患者服用糖皮质激素史,我们怀疑糖皮质激素激活乙型肝炎病毒导致的肝功能衰竭。住院期间患者接受抗病毒治疗的同时行人工肝治疗后肝功能明显改善。这说明乙型病毒性肝炎再激活导致的肝功能衰竭患者抗病毒治疗的同时行双重血浆分子吸附系统(double plasma molecular adsorb system, DPMAS)模式拟行人工肝治疗明显改善患者预后,缓解血源紧张问题。Glucocorticoids are mediators of the nervous and immune systems.They are clinically used as first-line drugs in the treatment of allergy,autoimmune and chronic inflammatory diseases.High doses and long-term use of glucocorticoids can result in hormone-induced immunosuppression,hyperglycemia,secondary infections,and osteoporosis.However,glucocorticoid-induced hepatitis B virus reactivation is rare.We report a history of viral hepatitis B in a Rh-negative blood group patient who developed poor appetite,abdominal distension,and hepatic decline including jaundice after 1 year of oral glucocorticoid therapy due to membranous nephropathy.Given the patient′s history of glucocorticoid use,we suspect that glucocorticoid activation of hepatitis B virus caused liver failure.During hospitalization,the patient received antiviral therapy and artificial liver therapy,and the liver function improved significantly.These results indicate that dual plasma molecular adsorption system(DPMAS)model of artificial liver therapy combined with antiviral therapy can significantly improve the prognosis of patients with liver failure caused by viral hepatitis B reactivation and alleviate the problem of blood source tension.

关 键 词：乙肝病毒再激活 肝功能衰竭 皮质醇 Rh血型阴性 

分 类 号：R575.3[医药卫生—消化系统]