摘要
目的探讨重型再生障碍性贫血(SAA)以抗淋巴细胞球蛋白/抗胸腺细胞球蛋白(ALG/ATG)为主的免疫抑制治疗(IST)疗效、疗效相关因素及相关并发症。方法应用ALG/ATG对41例SAA患者进行治疗,辅以环孢菌素A、雄激素、造血生长因子等。结果随访的33例中基本治愈7例(21.21%),达到缓解6例(18.18%),明显进步7例(21.21%),总有效率60.61%。单项资料对比分析显示,治疗有效率与年龄、性别、病程长短、SAA类型、治疗前骨髓增生程度及全身骨髓代谢程度等无明显相关性,但治疗前外周血中性粒细胞计数(ANC)≥0.2×109/L者有效率显著增高(P<0.05),IST治疗后发生严重感染者预后不佳,且治疗过程中发生严重感染者治疗初期输注血小板依赖时间较长(P<0.05)。所有患者治疗过程中出现不同程度发热15例(36.59%),皮疹2例(4.88%),血清病5例(12.20%)。随访患者出现远期并发症者2例:骨髓增生异常综合征(MDS)样病态造血1例,阵发性睡眠性血红蛋白尿症(PNH)1例。结论ALG/ATG作为重要免疫抑制剂治疗SAA疗效肯定,其相关不良反应可获得较好控制,而治疗前患者外周血ANC可能对疗效判断有提示意义。IST后出现重度感染多为预后不良的重要因素之一。
Objective To analyze the effectiveness of antilymphoeyte globulin/antithymoeyte globulin （ALG/ATG） in treatment of severe aplastie anemia （SAA）. Methods Forty-one patients with severe aplastic anemia were treated with ALG/ ATG, assisting with cyelosporine A, andrin, and granulocyte colony-stimulating factor. Results Thirty-three patients were followed up. The healing rate was 21.21 % （7/33）, the remission rate 18.18 % （6/33）, and the obvious improvement rate 21.21 % （7/33）. The overall effective rate was 60.61%. The effective rate was not related with age, sex, course of disease, SAA subtypes, proliferation degree before treatment and ECT of bone marrow, whereas the patients with neutrophil counts （ANC） less than 0.2 ×10^9/L had a lower remission rate （P〈0.05）. The patients with severe infection during the treatment had a prolonged platelet transfusion （P〈0.05）. The adverse reaction rate of [ever, skin rash and serum sickness was 36.59 （15/41）, 4.88% （2/41）, 12.20 % （ 5/41 ） respectively. During the follow-up of 33 patients, long-term complications occurred in 2 cases： 1 ease of myelodysplastlc syndrome （MDS） and 1 case of paroxysmal nocturnal hemoglobinuria （PNH）. Conclusion ALG/ATG in treatment of severe aplastic anemia was valid and safe. ANC would be a prognostic factor for efficiency in SAA. Severe infection after IST may be the major one of the poor prognostic factors.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2006年第2期253-255,共3页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
