Adachi Y, Usuki K, Kazama H, Iki S, Matsuya S, Urabe A
Division of Hematology, NTT Kanto Medical Center.
Rinsho Ketsueki. 2001 Sep;42(9):691-5.
A 28-year-old man developed cryptogenic hepatitis in January 1999, and treatment with glycyrrhizic acid improved his liver function. From June, however, pancytopenia began to develop gradually. The patient received G-CSF against leukocytopenia (WBC 1,100/microliter, neutrophils 590/microliter) and was transferred to our hospital in August 1999. A diagnosis of hepatitis-associated aplastic anemia was made on the basis of liver dysfunction (AST 156 IU/l, ALT 386 IU/l), hypoplastic bone marrow, and pancytopenia (WBC 4,400/microliter, neutrophils 3,340/microliter under G-CSF administration, Hb 9.8 g/dl, platelets 2.4 x 10(4)/microliter, reticulocytes 4.7 x 10(4)/microliter). Immediately after starting combined therapy with ATG, cyclosporin, and G-CSF, his liver function began to improve and was normalized on day 7. Pancytopenia began to ameliorate on day 9, and blood parameters on day 60 were WBC 4,200/microliter (without G-CSF administration), Hb 12.0 g/dl, platelets 9.0 x 10(4)/microliter, and reticulocytes 4.1 x 10(4)/microliter. Although the prognosis of hepatitis-associated aplastic anemia is generally poor, immunosuppressive therapy was markedly effective for both pancytopenia and hepatic dysfunction in the present case.
一名28岁男性于1999年1月患上隐源性肝炎，使用甘草酸治疗后肝功能有所改善。然而，从6月开始，全血细胞减少症逐渐出现。患者因白细胞减少（白细胞计数1100/微升，中性粒细胞590/微升）接受了粒细胞集落刺激因子（G-CSF）治疗，并于1999年8月转至我院。根据肝功能障碍（谷草转氨酶156国际单位/升，谷丙转氨酶386国际单位/升）、骨髓增生低下和全血细胞减少（白细胞计数4400/微升，在使用G-CSF治疗下中性粒细胞3340/微升，血红蛋白9.8克/分升，血小板2.4×10⁴/微升，网织红细胞4.7×10⁴/微升），诊断为肝炎相关性再生障碍性贫血。在开始使用抗胸腺细胞球蛋白（ATG）、环孢素和G-CSF联合治疗后，他的肝功能立即开始改善，并在第7天恢复正常。全血细胞减少症在第9天开始改善，第60天的血液参数为白细胞计数4200/微升（未使用G-CSF），血红蛋白12.0克/分升，血小板9.0×10⁴/微升，网织红细胞4.1×10⁴/微升。虽然肝炎相关性再生障碍性贫血的预后通常较差，但在本病例中，免疫抑制治疗对全血细胞减少症和肝功能障碍均有显著疗效。
