目的 探讨再生障碍性贫血合并乙肝肝炎临床特点、治疗方案及预后。方法 收集2010年1月-2016年12月我院50例肝 炎相关性再生障碍性贫血（HAAA）患者及50例重型再生障碍性贫血（SAA）患者临床资料，对比HAAA组与SAA组临 床表现、血常规、肝功能、骨髓涂片和骨髓活检、治疗情况及预后转归。结果 HAAA组与SAA组均存在程度不一贫 血、出血、感染等症状，两组贫血、出血、发热程度分级比较均无显著差异（P>0.05）。HAAA组在诊断AA时较诊 断为肝炎时ALT、AST水平明显降低（P<0.05）。HAAA组较SAA组WBC、PLT、ANC等水平明显降低（P<0.05）。HAAA 组较SAA组粒系、造血面积均显著减少（P<0.05），脂肪面积、骨小梁面积显著增大（P<0.05）。两组患者均给 予司坦唑醇、造血生长因子等骨髓造血刺激药物治疗，并给予相关对症治疗。HAAA组较SAA组生存时间明显缩短 （P<0.05）。结论 AA合并乙型肝炎与无肝炎合并AA症状表现无明显差别，均有各种程度贫血、出血、发热等症 状，但AA合并乙型肝炎WBC、PLT、ANC水平明显降低，骨髓抑制更为严重，可提示预后更差。

Objective To explore the clinical characteristics, treatment and prognosis of patients with aplastic anemia complicated with hepatitis B. Methods From Jan. 2010 to Dec. 2016, 50 patients with hepatitis associated aplastic anemia (HAAA) and 50 patients with severe aplastic anemia (SAA) in our hospital were taken as the clinical objects. The clinical manifestations, blood routine test, liver function, bone marrow smear, bone marrow biopsy, treatment and prognosis in HAAA group and SAA group were compared. Results There were varying symptoms such as anemia, bleeding, infection and so on in the two groups, but their differences were not statistically significant(P>0.05). When the hepatitis patients in the HAAA group were diagnosed as AA, their ALT and AST levels were significantly decreased(P<0.05). The WBC, PLT and ANC levels in the HAAA group were obviously lower than those in the SAA group(P<0.05). Compared with the SAA group, the granulocyte and hematopoietic area in the HAAA group were significantly decreased(P<0.05), but the fat and trabecular area in the HAAA group were increased significantly(P<0.05). Both groups were given stanozolol, hematopoietic growth factor and other bone marrow hematopoietic stimulating drugs, and related symptomatic treatment. The survival time of HAAA group was significantly shorter than that of SAA group(P<0.05). Conclusion There was no significant difference in the symptoms between AA complicated with hepatitis Band AA, all of which have varying degrees of anemia, bleeding, fever and other symptoms. The levels of WBC, PLT and ANC in patients with AA complicated with hepatitis B are significantly lower, and the bone marrow depression is more serious, which may lead to worse prognosis.