摘要
目的探讨再生障碍性贫血(AA)并发EB病毒(EBV)-淋巴细胞增殖性疾病(LPD)患者的临床特征及其诊疗方法。方法选择2019年8月7日,于河北医科大学附属平安医院收治的1例AA并发EBV-LPD患者为研究对象。本例患者为男性,60岁。根据血常规、外周血细胞形态学、骨髓细胞形态学与流式细胞术免疫分型,以及外周血EBV核酸及淋巴瘤基因重排检查等结果,对患者进行诊断,以及环孢素为主的免疫抑制治疗(IST)。本研究对患者随访截至2020年2月26日。采用回顾性分析方法,对患者的临床表现与诊治过程进行分析。检索中国知网数据库、万方数据服务知识平台、PubMed数据库中与本研究患者相似的接受IST后并发LPD相关文献。文献检索时间为数据库建库至2020年2月20日。总结与本例AA并发EBV-LPD患者相关的临床表现、诊治及预后等资料。本研究获得河北医科大学附属平安医院伦理学委员会审批(批准文号:2019-08-13),并与患者签署临床研究知情同意书。结果①病史采集:本例患者因"间断面色苍白、乏力、皮肤淤斑5年8个月,便血1周"入院。患者于2013年11月被诊断为慢性AA,并接受以环孢素为主的IST治疗。②本次入院实验室检查结果:血常规结果示,白细胞计数(WBC)、红细胞计数(RBC)、血红蛋白(Hb)值、血小板计数分别为20.37×10^(9)/L、1.61×10^(12)/L、60 g/L、2×10^(9)/L。外周血涂片结果示,有核细胞多见,幼稚、成熟淋巴细胞比例分别为38%、35%。骨髓细胞形态学检查结果示,有核细胞增生明显活跃,幼稚、成熟淋巴细胞比例分别为42%、45%。骨髓有核细胞免疫分型结果示,CD19+、CD5+CD23+细胞占有核细胞比例分别为58.3%和14.4%。淋巴瘤基因重排检查结果示,免疫球蛋白重链(IgH)FR1-JH基因重排、IgH FR2-JH基因重排、IgH DH-JH基因重排、免疫球蛋白κ链(Igκ)Vκ-Jκ基因重排均呈阳性。外周血病毒核酸检查结果示,EBV
Objective To investigate clinical features,diagnosis and treatment of Epstein-Barr virus(EBV)-lymphocytic proliferative disease(LPD)in plastic anemia(AA)patients.Methods On August 7,2019,a case of patient with AA complicated with EBV-LPD who was admitted at Ping′an Hospital Affiliated to Hebei Medical University was selected as research subject.The patient was male and 60 years old.Diagnosis and immunosuppressive therapy(IST)based treatment were made based on results of routine blood examination,peripheral blood and bone marrow morphology test,immunotyping by flow cytometry test,peripheral blood EBV nucleic acid test,lymphoma gene rearrangement test,etc..Follow-up of patient was conducted until February 26,2020.Clinical manifestations and process of diagnosis and treatment of the patient were analyzed retrospectively.China National Knowledge Infrastructure database,Wanfang Data Knowledge Service Platform,PubMed database were searched for the same or similar case reports as AA complicated with LPD in this study.Retrieval time was from database inception to February 20,2020.Clinical manifestations,diagnosis,treatment and prognosis related to the patient with AA complicated with EBV-LPD in this study were summarized.This study was approved by the Ethics Committee of Ping′an Hospital Affiliated to Hebei Medical University(Approval No.2019-08-13).Informed consent was obtained from the patient.Results①Results of medical history:the patient was admitted due to"intermittent pale complexion,fatigue,skin ecchymosis for 5 years and 8 months,and hematochezia for 1 week".The patient was diagnosed as chronic AA in November 2013 and was treated with a cyclosporin-based IST.②Results of related laboratory examinations after hospital admission were as follows.Results of peripheral blood and routine blood test show that white blood cell count(WBC),red blood cell count(RBC),hemoglobin(Hb)level and blood platelet count were 20.37×10^(9)/L,1.61×10^(12)/L,60 g/L and 2×10^(9)/L,respectively.Results of blood smear showed that
作者
张校辉
陶朝欣
白明明
郑凡
高习华
张玉娜
邢江涛
朱芸
Zhang Xiaohui;Tao Chaoxin;Bai Mingming;Zheng Fan;Gao Xihua;Zhang Yuna;Xing Jiangtao;Zhu Yun(Department of Laboratory Diagnostics,Ping′an Hospital of Hebei Medical University,Shijiazhuang 050021,Hebei Province,China;Department of Hematology,Ping′an Hospital of Hebei Medical University,Shijiazhuang 050021,Hebei Province,China;Department of Clinical Laboratory,Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China)
出处
《国际输血及血液学杂志》
2021年第3期232-240,共9页
International Journal of Blood Transfusion and Hematology
