一例补体抑制剂治疗欠佳的再生障碍性贫血-阵发性睡眠性血红蛋白尿患者的多学科诊疗分析

A Case of Aplastic Anemia-Paroxysmal Nocturnal Hemoglobinuria with Poor Response to Complement Inhibitor Treatment: Multidisciplinary Diagnostic and Therapeutic Analysis

  • 摘要: 一例青年男性患者诊断再生障碍性贫血伴阵发性睡眠性血红蛋白尿(paroxysmal nocturnal hemoglobinuria,PNH),经免疫抑制剂治疗后仅部分缓解。近1年贫血加重、输血依赖,考虑PNH活动性溶血所致,更换依库珠单抗治疗后贫血仍持续加重。详细询问病史发现患者慢性牙周感染,近1个月牙周疼痛溢脓伴发热。多学科讨论考虑慢性牙源性感染激活补体系统是PNH溶血加重的主要原因,急性感染影响了依库珠单抗的疗效。经多学科会诊制定治疗方案,给予静脉抗生素联合牙周冲洗、拔牙控制牙源性感染,同时继续按期输注依库珠单抗,患者临床症状好转,血红蛋白迅速上升,脱离血制品输注。该病例为通过多学科协作诊疗解决罕见病在新药物治疗中遇到的困难提供了经验参考。

     

    Abstract: A young male patient was diagnosed with aplastic anemia accompanied by paroxysmal nocturnal hemoglobinuria (PNH), and achieved only partial remission after immunosuppressive therapy. Over the past year, his anemia worsened, leading to transfusion dependence, which was considered to be caused by active hemolysis of PNH. Despite switching to eculizumab treatment, his anemia continued to deteriorate. A detailed medical history revealed chronic periodontal infection, with periodontal pain, purulent discharge, and fever in the past month. Multidisciplinary discussion suggested that chronic odontogenic infection activating the complement system was the primary cause of aggravated PNH hemolysis, and the acute infection affected the efficacy of eculizumab. Based on multidisciplinary consultation, a treatment plan was formulated, including intravenous antibiotics combined with periodontal irrigation and tooth extraction to control odontogenic infection, while continuing regular eculizumab infusion. The patient′s symptoms improved, hemoglobin levels rose rapidly, and he was no longer transfusion-dependent. This case provides an empirical reference for addressing difficulties encountered in the treatment of rare diseases with new drugs through multidisciplinary collaborative diagnosis and treatment.

     

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