Andriani A, Bibas M, Callea V, De Renzo A, Chiurazzi F, Marcenò R, Musto P, Rotoli B
Divisione di Medicina, Ospedale San Giacomo, Roma, Italy.
Haematologica. 1996 May-Jun;81(3):258-60.
BACKGROUND. A number of side effects have been observed in patients treated for hematological diseases with alpha-interferon (IFN). In several cases side effects consisted of immunological disorders. Autoimmune hemolytic anemia (AIHA) is the most typical example of an IFN-induced immune-mediated complication. CASE SERIES. In 10 years we observed 9 patients with various hematological disorders who developed AIHA during IFN treatment. The interval between the start of IFN treatment and the onset of acute hemolysis suggests a dual pattern of occurrence: (1) early onset (interval 1 to 21 days), seen in patients who had anti-RBC antibodies before IFN treatment; (2) late onset (interval 3-38 months), in patients with no history of anti-RBC antibodies at the start of treatment. Discontinuation of IFN, often associated with prednisone treatment, caused prompt hematological recovery in all cases; anti-erythrocyte antibodies persisted in the first group of patients and disappeared in the second. CONCLUSIONS. In rare cases IFN may cause AIHA. The immunological derangement caused by IFN seems to act at two different levels: enhanced destruction of antibody-coated RBCs and induction of autoreactive B-cells. As for the possibility of other preexisting immunological disorders, AIHA (even latent) is a contraindication to IFN treatment. Patients treated with IFN need accurate monitoring to guard against for the development of autoimmune disorders.
背景。在用α-干扰素（IFN）治疗血液系统疾病的患者中观察到了多种副作用。在一些病例中，副作用表现为免疫紊乱。自身免疫性溶血性贫血（AIHA）是IFN诱导的免疫介导并发症的最典型例子。病例系列。在10年里，我们观察到9例患有各种血液系统疾病的患者在IFN治疗期间发生了AIHA。IFN治疗开始至急性溶血发作之间的间隔提示了两种发生模式：（1）早发（间隔1至21天），见于在IFN治疗前就有抗红细胞抗体的患者；（2）晚发（间隔3至38个月），见于治疗开始时无抗红细胞抗体病史的患者。停用IFN（通常联合泼尼松治疗）在所有病例中均导致血液学迅速恢复；抗红细胞抗体在第一组患者中持续存在，在第二组患者中消失。结论。在罕见情况下，IFN可能导致AIHA。IFN引起的免疫紊乱似乎在两个不同水平起作用：增强抗体包被红细胞的破坏和诱导自身反应性B细胞。至于其他既往存在的免疫紊乱的可能性，AIHA（即使是潜在的）是IFN治疗的禁忌证。接受IFN治疗的患者需要进行准确监测，以预防自身免疫性疾病的发生。
