由于疾病的罕见,阵发性睡眠性血红蛋白尿(PNH)的自然病程尚不明确。以后,特殊的疗法出现后可能会改变这种疾病的自然病程。[26]Kelly RJ, Hill A, Arnold LM, et al. Long-term treatment with eculizumab in paroxysmal nocturnal hemoglobinuria: sustained efficacy and improved survival. Blood. 2011;117:6786-6792.http://www.bloodjournal.org/content/117/25/6786.longhttp://www.ncbi.nlm.nih.gov/pubmed/21460245?tool=bestpractice.com美国和欧洲人群的大部分研究表明,诊断后的中位生存时间为10-15年。[9]Hillmen P, Lewis SM, Bessler M, et al. Natural history of paroxysmal nocturnal haemoglobinuria. New Engl J Med. 1995;333:1253-1259.http://www.nejm.org/doi/full/10.1056/NEJM199511093331904#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/7566002?tool=bestpractice.com[16]Nishimura J, Kanakura Y, Ware RE, et al. Clinical course and flow cytometric analysis of paroxysmal nocturnal hemoglobinuria in the United States and Japan. Medicine (Baltimore). 2004;83:193-207.http://www.ncbi.nlm.nih.gov/pubmed/15118546?tool=bestpractice.com[22]Socie G, Mary JY, de Gramont A, et al. Paroxysmal nocturnal haemoglobinuria: long term follow-up and prognostic factors. Lancet. 1996;348:573-577.http://www.ncbi.nlm.nih.gov/pubmed/8774569?tool=bestpractice.com东亚人群的生存时间可能更长,因为这部分人群的血栓发生率明显偏低,而这似乎是欧洲人群中预后最差的并发症。更罕见的是,PNH克隆似乎能自发的消失。[9]Hillmen P, Lewis SM, Bessler M, et al. Natural history of paroxysmal nocturnal haemoglobinuria. New Engl J Med. 1995;333:1253-1259.http://www.nejm.org/doi/full/10.1056/NEJM199511093331904#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/7566002?tool=bestpractice.com[16]Nishimura J, Kanakura Y, Ware RE, et al. Clinical course and flow cytometric analysis of paroxysmal nocturnal hemoglobinuria in the United States and Japan. Medicine (Baltimore). 2004;83:193-207.http://www.ncbi.nlm.nih.gov/pubmed/15118546?tool=bestpractice.com
PNH合并再生障碍性贫血
临床病程取决于再生障碍性贫血的程度和反应性。西方人群中,既往是否存在再生障碍性贫血的病史,似乎并不影响血栓形成的发生以及总体生存率。[13]de Latour RP, Mary JY, Salanoubat C, et al. Paroxysmal nocturnal hemoglobinuria: natural history of disease subcategories. Blood. 2008;112:3099-3106.http://www.bloodjournal.org/content/112/8/3099.fullhttp://www.ncbi.nlm.nih.gov/pubmed/18535202?tool=bestpractice.com
亚临床PNH
到目前为止,只有极少的关于仅有微量PNH细胞的患者的预后的数据。一部分患者会发展为明确的有溶血和血栓形成的阵发性睡眠性血红蛋白尿(PNH)。因此,应对这些患者每年进行监测。通过检查这些患者血细胞的PNH缺陷,以确定PNH克隆规模保持在较小范围内。[2]Parker C, Omine M, Richards S, et al. Diagnosis and management of paroxysmal nocturnal hemoglobinuria. Blood. 2005;106:3699-3709.http://www.bloodjournal.org/content/106/12/3699.fullhttp://www.ncbi.nlm.nih.gov/pubmed/16051736?tool=bestpractice.com