Wu J, Han X X, Di H, Yin Y, Han Y D, Wang Y, Zhang Y, Zeng X J
Department of Family Medicine & Division of General Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, State Key Laboratory of Complex Severe and Rare Diseases, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2023 Aug 1;62(8):1007-1011. doi: 10.3760/cma.j.cn112138-20220819-00610.
We wished to summarize the clinical features of common variable immunodeficiency (CVID) complicated by non-cirrhotic portal hypertension (NCPH) and to deepen our understanding of it. The case data of CVID complicated with NCPH admitted to Peking Union Medical College Hospital from January 1983 to May 2021 were analyzed retrospectively to summarize their clinical characteristics. Six patients with CVID combined with NCPH (three of each sex; 16-45 years) were assessed. Four patients had portal hypertension. All patients had anemia, splenomegaly, a normal serum level of albumin and transaminases, and possibly increased levels of alkaline phosphatase and gamma-glutamyl transpeptidase. Two patients were diagnosed with esophagogastric fundic varices by gastroscopy. Two patients underwent splenectomy (which improved hematologic abnormalities partially). Four patients had autoimmune disease. Two cases were diagnosed with nodular regenerative hyperplasia (NRH) upon liver biopsy. Six patients were administered intravenous immunoglobulin-G (0.4-0.6 g/kg bodyweight) once every 3-4 weeks as basic therapy. Often, CVID complicated with NCPH has: (1) The manifestations of portal hypertension as the primary symptom. (2) Autoimmune-related manifestations. Imaging can provide important diagnostic clues. The etiology may be related to hepatic NRH and splenomegaly due to recurrent infections.
我们希望总结常见变异型免疫缺陷(CVID)合并非肝硬化性门静脉高压(NCPH)的临床特征,并加深对其的理解。回顾性分析1983年1月至2021年5月在北京协和医院收治的CVID合并NCPH的病例资料,以总结其临床特点。评估了6例CVID合并NCPH的患者(男女各3例;年龄16 - 45岁)。4例患者有门静脉高压。所有患者均有贫血、脾肿大、血清白蛋白和转氨酶水平正常,碱性磷酸酶和γ-谷氨酰转肽酶水平可能升高。2例患者经胃镜检查诊断为食管胃底静脉曲张。2例患者接受了脾切除术(部分改善了血液学异常)。4例患者有自身免疫性疾病。2例经肝活检诊断为结节性再生性增生(NRH)。6例患者接受静脉注射免疫球蛋白G(0.4 - 0.6 g/kg体重),每3 - 4周1次作为基础治疗。通常,CVID合并NCPH有:(1)以门静脉高压表现为主要症状。(2)自身免疫相关表现。影像学检查可提供重要诊断线索。病因可能与反复感染导致的肝脏NRH和脾肿大有关。