Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
J Pediatr. 2020 Dec;227:87-93.e2. doi: 10.1016/j.jpeds.2020.08.028. Epub 2020 Aug 14.
To assess the prognostic role of hepatitis in pediatric patients with aplastic anemia and the incidence of hepatitis B among patients with hepatitis-associated aplastic anemia in an area with a previously high prevalence of hepatitis B after nationwide hepatitis B vaccination for 30 years.
Pediatric patients (n = 78) with aplastic anemia were enrolled in this study, including 9 with hepatitis-associated aplastic anemia. We collected the clinical characteristics, etiologies of the aplastic anemia, hepatitis B virus serology and serum hepatitis B viral load, response to the treatments, and survival outcome from the participants. We applied univariate and multivariate Cox regression analysis to evaluate the correlations between clinical features and survival outcome. Survival analysis was done using Cox regression model and Kaplan-Meier curves.
Patients with hepatitis-associated aplastic anemia were related to significantly worse survival prognosis when compared with patients with non-hepatitis-associated aplastic anemia, and hepatitis-associated aplastic anemia was the only independent prognostic factor to predict a poor survival outcome in our patients with aplastic anemia by multivariable analysis. In none of the total 78 patients was aplastic anemia related to hepatitis B virus infection.
Patients with hepatitis-associated aplastic anemia had a significantly worse prognosis when compared with patients whose aplastic anemia was not hepatitis-associated. This study demonstrates the potential benefit of hepatitis B vaccination in decreasing the incidence of hepatitis-associated aplastic anemia in children.
评估乙型肝炎在接受了 30 年全国性乙型肝炎疫苗接种后乙型肝炎发病率高的地区的儿童再生障碍性贫血患者中的预后作用，以及乙型肝炎相关性再生障碍性贫血患者中的乙型肝炎发生率。
本研究纳入了 78 例再生障碍性贫血的儿科患者，包括 9 例乙型肝炎相关性再生障碍性贫血患者。我们收集了患者的临床特征、再生障碍性贫血的病因、乙型肝炎病毒血清学和血清乙型肝炎病毒载量、治疗反应和生存结局。我们应用单因素和多因素 Cox 回归分析评估了临床特征与生存结局之间的相关性。生存分析采用 Cox 回归模型和 Kaplan-Meier 曲线进行。
与非乙型肝炎相关性再生障碍性贫血患者相比，乙型肝炎相关性再生障碍性贫血患者的生存预后显著较差，并且多因素分析表明，乙型肝炎相关性再生障碍性贫血是预测再生障碍性贫血患者不良生存结局的唯一独立预后因素。在 78 例患者中，无一例再生障碍性贫血与乙型肝炎病毒感染有关。
与非乙型肝炎相关性再生障碍性贫血患者相比，乙型肝炎相关性再生障碍性贫血患者的预后显著较差。本研究表明乙型肝炎疫苗接种可降低儿童乙型肝炎相关性再生障碍性贫血的发生率。
