摘要
目的 探讨各种免疫抑制 (IS)治疗儿童再生障碍性贫血 (简称再障 ) ,尤其是重型再障(SAA)的临床疗效。方法 阶段性总结各种IS治疗 :抗胸腺细胞球蛋白 (ATG)、环胞菌素A(CSA)、大剂量免疫球蛋白 (HDIG)和联合IS治疗儿童再障的疗效 ,将以往以雄性激素为主的治疗作为IS治疗疗效的对照组。结果 (1)IS治疗疗效明显优于雄性激素对照组 ,尤其是SAA有效率明显高于对照组 (P <0 0 5 ) ;(2 )联合IS治疗SAA在提高疗效和降低病死率等方面均明显优于单药IS治疗 (P均 <0 0 5 ) ;(3)疗效影响因素的分析提示 ,单药ATG或CSA治疗前病程 <6个月者有效率高 (P <0 0 5 ) ,而联合IS治疗疗效与病程无明显关系 ;(4)采用副反应综合防治措施 ,能使各种IS治疗顺利实施 ;(5 )雄性激素是IS治疗的有效辅助治疗方法。结论 ATG、CSA和HDIG确为治疗儿童再障 ,尤其是SAA和难治型再障的有效疗法 。
Objective Withstatisticalmethodstoanalyzetheclinicaloutcomesofimmunosuppressive therapy (IS)forchildhoodaplasticanemia (AA) ,especiallyforsevereAA (SAA) .Methods Totally 182cases withchildhoodAAseenduringtherecenttenyearswereincludedinthisstudy.Thepatients′agerangedfrom 1 14 years.Thirtycasesweretreatedwithantithymocyteglobulin (ATG) ,18withcyclosporineA (CsA) ,9withhigh doseimmunoglobulin (HDIG)and 2 1withcombinedIStherapy (2 4immunosuppressants) ,respectively .One hundredandfourcasestreatedwithandrogensbasedtherapywereusedasacontrolgroup .Theclinicaloutcomesof allkindsofIStherapiesweresequentiallysummarizedbyRiditmethod .Results (1)Thetotalresponseratesof combinedISforSAA IandSAA II ,andasingleIStherapy (CsA ,ATGorHDIG)forSAA IIweresignificantly higherthanthatofthecontrolgroup (P <0 .0 5 ) .(2 )IncombinedIStherapygroup ,therewere 5 7.1%ofthe SAAgotcompleteremissionwhile 30 %inthesingleIStherapygroupdidso (P <0 .0 5 ) .Themortalityrateswere 4.8%incombinedISgroupand 2 5 .0 %inthesingleISgroup ,respectively (P <0 .0 5 ) .Thedatashowedthat theclinicalefficacyofcombinedISwassuperiortothatofsingleISatimprovingresponsegradeandsurvival.(3) . Thestudyonpredictivefactorsindicatedthatthereponseratesofthepatientswhohadtheirdiseaseforlessthan 6 monthsbeforetreatmentwithATGorCsA (78.6 %and 90 .0 % )weresignificantlyhigherthanthatofpatientswho hadtheirdiseaseforlongerthan 6months (37.5 % ,P <0 .0 5 ) .(4)IStherapycouldbesafelycarriedoutby carefulprophylaxisandtreatmentofcomplicationsrelatedtothetherapythatwasoneofthemostcriticalconcerns inclinicaltreatmentforAA .(5 )AndrogenscouldincreasetheresponserateofIStherapy .Conclusion ATG , CsAandHDIGwereveryeffectiveintreatmentofchildhoodAA ,especiallyforSAA .CombinedIStherapymay furtherimprovetheresponseandsurvivalrate .Androngenscouldbeaveryuseful supplementin IS therapy for childhood AA .随
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2001年第8期484-487,共4页
Chinese Journal of Pediatrics
