演題詳細

一般口演 / Oral Session

一般口演 107 (Oral Session 107) :ウイルス感染症/血球貪食症候群

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日程
2013年10月13日(日)
時間
15:00 - 16:00
会場
第14会場 / Room No.14 (札幌市教育文化会館 3F 研修室305)
座長・司会
森 慎一郎 (Shinichiro Mori):1
1:聖路加国際病院 血液腫瘍内科
 
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Characterization of hepatitis virus-associated hemophagocytic lymphohistiocytosis

演題番号 : OS-3-184

白土 基明 (Motoaki Shiratsuchi):1、高松 明子 (Akiko Takamatsu):1、池田 元彦 (Motohiko Ikeda):1、本多 絵美 (Emi Honda):1、大野 博文 (Hirofumi Ohno):1、中嶋 康博 (Yasuhiro Nakashima):1、安部 康信 (Yasunobu Abe):2、古藤 和浩 (Kazuhiro Kotoh):1、松島 孝充 (Takamitsu Matsushima):1、高柳 涼一 (Ryoichi Takayanagi):1

1:Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka, Japan、2:Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

 

Background: In acute viral hepatitis A (HAV) and B (HBV), viral antigen specific-cytotoxic T cells are developed and induce cytokine production. Excess cytokines activate macrophages and cause hemophagocytic lymphohistiocytosis (HLH). To characterize hepatitis virus (HV)-associated HLH, we compared those cases with EB virus-associated HLH.Methods: We analyzed 8 acute viral hepatitis patients (HAV 3, HBV 5) with cytopenias and hemophagocytosis in their bone marrow. Their laboratory data and bone marrow findings are compared with those of 9 EBV-HLH cases. Results: Median ages of hepatitis-HLH and EBV-HLH are 40.5 years and 19 years, respectively. The level of ALT was significantly higher in HV group than EBV group (4920 vs 256 IU/L). WBC and platelet counts were lower (4455 vs 2580 /μL and 10.7 vs 3.5 x104/μL, respectively) and CRP and sIL-2R are higher in EBV group significantly (2.59 vs 6.34 mg/dL and 2102 vs 10894 U/mL, respectively). Serum ferritin and LDH levels were not different. The numbers of atypical lymphocytes in the bone marrow were significantly higher in EBV group (2.4 vs 16.1%). All HV-HLH cases received arterial or systemic steroid injection and anti-viral agents were administered in HBV-HLH cases. Six of eight cases achieved remission, one sustained, and one died of multiorgan failure.Conclusion: In HV-HLH, cytopenias were milder and liver dysfunction was more severe. HAV and HBV infect in hepatocytes and cytotoxic T cells against the viral antigens are induced. Strong immune reaction occurs in the liver and steroid local injection was quite effective.

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