摘要
目的目前重型再生障碍性贫血的主要治疗手段之一是免疫抑制治疗，而抗胸腺球蛋白／抗淋巴细胞球蛋白（ATG／ALG）是其中重要的药物。该文通过回顾性分析临床资料，探讨ATG／ALG治疗重型再生障碍性贫血的疗效及其并发症的防治。方法对1994年12月至2005年9月收治的28例诊断为重型再生障碍性贫血并接受ATG／ALG治疗的患儿的临床资料进行分析。结果28例患儿中，基本治愈2例（7．1％），缓解4例（14．3％），进步12例（42．9％），总有效率64．3％。19例出现血清病样反应，主要表现发热9例，皮疹12例，关节痛7例，肌肉痛7例，关节肿胀3例。发生时间为用药后5～17d，持续时间1～15d，平均4．4d。3例轻症者未经处理自行缓解。其余16例给予甲基泼尼松龙每日10mg／kg，静脉推注每天1次，连用3～5d，症状均消失。3例于停用甲基泼尼松龙2～4d后再次出现血清病症状，再次给予甲基泼尼松龙后症状消失。无血清病及血清病反应轻微者ATG／ALG疗效明显优于血清病反应重者（P〈0．05）。结论ATG／ALG治疗重型再生障碍性贫血疗效肯定，血清病为治疗中常见的不良反应，应用甲基泼尼松龙3—5d可较好控制血清病症状。
Objective lmmunsuppressive therapy is a major therapy for severe aplastic anemia, and antithymocyte / antilymphocyte globulin （ATG/ALG） is usually used. This study investigated the therapeutic effect of ATG/ALG on severe aplastic anemia and explored the management of therapy-related complications. Methods Clinical data of 28 children with severe aplastic anemia who received ATG/ALG treatment from December, 1994 through to September, 2005 were analyzed retrospectively. Results Of the 28 patients, 2 were nearly cured （7. 1% ） , 4 were relieved （ 14.3% ） and 12 were improved （42.9%） based on a hemoglobin/white blood cell/platelet count. These results represented an overall effective rate of 64.3%. Clinical evidence of serum sickness developed in 19 patients, manifesting as fever （n = 9）, cutaneous eruptions （n = 12）, arthralgias （n = 7 ）, myalgia （n = 7） and arthrocele （n = 3 ）. Serum sickness occurred 5-17 clays after ATG/ALG administration and lasted for 1-15 days （mean 4.4 days）. Three children with miht serum sickness symptoms recovered without any treatment. The symptoms of the other 16 patients disappeared arier 3-5 days of methylprednisolone treatment （10 mg/kg daily）. However, 3 patients had relapses at 2-4 clays after termination of methylprednisolone therapy. Another course of methylprednisohme therapy was administered to the 3 patients until the symptoms disappeared. The patients with no serum sickness or with mild serum sickness had a better response to ATG/ ALG therapy than those who had severe serum sickness （ 100%, vs 60% ; P 〈 0.05 ）. Conclusions ATG/ALG therapy for severe aplastic anemia is effective. Serum sickness is a common complication in children with severe aplastic anemia following ATG/ALG therapy, but can be improved by methylprednisolone application.
出处
《中国当代儿科杂志》
CAS
CSCD
2006年第6期479-481,共3页
Chinese Journal of Contemporary Pediatrics
