Garmaeva T Ts, Kulikov S M, Mikhaĭlova E A, Gemdzhian E G, Gaponova T V, Grumbkova L O, Iaroslavtseva N G, Tupoleva T A, Somova A V, Makarik T A, Glinshchikova O A, Fevraleva I S, Sudarikov A B, Filatov F P, Savchenko V G
Ter Arkh. 2011;83(7):17-26.
To specify trends in clinical and laboratory manifestations of virus hepatitis B and C (HBV and HCV) in patients with blood diseases from the moment of the first positive specific tests for HBV and HCV markers; to assess effects of HBV and HCV infection on efficacy of treatment of blood disease treatment, i.e. lifespan of patients with hematological diseases.
The study enrolled 257 patients: 205 with acute leukemia - AL, 40 with lymphoproliferative diseases, 4 - with CML and 8 - others; 8 healthy bone marrow donors. The patients were admitted to Russian Hematological Research Center in 2004-2006 Follow-up median was 253 days. A total of 7800 biological samples were studied, among them about 4000 tests for HBV DNA and HCV RNA.
Positive tests for specific markers of HBV and HCV were absent only in 78 (29.4%) patients. Positive markers of coinfection were detected in 57 (32.8%) of 174 patients with HBV infection and in 81.4% of 70 patients with HCV infection. Probability of detection of HCV markers after positive tests for HBV markers and vice versa is about 3 times higher than probability of their isolated detection. Among patients infected with HBVsymptoms of hepatitis B are likely to appear in 56% patients to day 500 of follow-up from the date of the first positive specific test. Median of the interval between the first positive test for HBV markers and probable clinical signs of hepatitis was 30 days. Among patients with HCV infection, 85% develop hepatitis to follow-up day 300 since the date of the first specific positive test. Almost 100% patients infected with two viruses develop hepatitis to follow-up day 600. Median of the interval between the first positive test for HBV and HCV markers and probable hepatitis picture was 47 days. Overall 3-year survival of AL patients was 40%, of patients with lymphoproliferative diseases - 58%. Overall 7-month survival was 75% in AA patients. HBV infection in patients with blood disease is associated with high risk of death, especially in AA and AL. Association between HCV infection and survival is not proved.
A high rate of clinical realization of viral hepatitis B and C, especially in coinfection, calls for virological and clinical monitoring of patients with any positive test for HBV and HCV markers.
明确自首次乙肝病毒（HBV）和丙肝病毒（HCV）特异性检测呈阳性起，血液病患者中HBV和HCV感染的临床及实验室表现趋势；评估HBV和HCV感染对血液病治疗疗效（即血液病患者生存期）的影响。
本研究纳入257例患者，其中急性白血病（AL）患者205例、淋巴增殖性疾病患者40例、慢性粒细胞白血病（CML）患者4例、其他患者8例；8名健康骨髓供者。2004年至2006年，这些患者被收治于俄罗斯血液病研究中心。随访时间中位数为253天。共研究了7800份生物样本，其中约4000份进行了HBV DNA和HCV RNA检测。
仅78例（29.4%）患者HBV和HCV特异性标志物检测呈阴性。174例HBV感染患者中，57例（32.8%）检测到合并感染阳性标志物；70例HCV感染患者中，该比例为81.4%。HBV标志物检测呈阳性后检测到HCV标志物的概率，以及反之亦然的概率，比单独检测到它们的概率高约3倍。在感染HBV的患者中，56%的患者在首次特异性检测呈阳性之日起至随访第500天可能出现乙肝症状。HBV标志物首次检测呈阳性与可能出现肝炎临床体征之间的间隔时间中位数为30天。在HCV感染患者中，自首次特异性检测呈阳性之日起至随访第300天，85%的患者会出现肝炎。几乎100%感染两种病毒的患者在随访第600天会出现肝炎。HBV和HCV标志物首次检测呈阳性与可能出现肝炎表现之间的间隔时间中位数为47天。AL患者的3年总生存率为40%，淋巴增殖性疾病患者为58%。再生障碍性贫血（AA）患者的7个月总生存率为75%。血液病患者中的HBV感染与高死亡风险相关，尤其是在AA和AL患者中。未证实HCV感染与生存率之间存在关联。
HBV和HCV病毒肝炎的临床发生率较高，尤其是合并感染时，这就需要对HBV和HCV标志物检测呈阳性的患者进行病毒学和临床监测。
