异基因外周造血干细胞移植与免疫抑制治疗重型再生障碍性贫血的临床比较  

Comparative study of allogeneic peripheral blood stem cell transplantation and immunosuppressive therapy for severe aplastic anemia

作　　者：许多荣[1] 刘俊茹[1] 邹外一[1] 王荷花[1] 黄珊[1] 李娟[1] 

机构地区：[1]中山大学附属第一医院血液科,广州510080

出　　处：《中国医师进修杂志（内科版）》2008年第10期22-25,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较异基因外周造血干细胞移植（Allo—PBSCT）与免疫抑制治疗（IST）重型再生障碍性贫血（SAA）的疗效与并发症。方法25例SAA患者接受了两种方法治疗：PBSCT组12例接受了同胞HLA全相合的PBSCT，预处理方案为：环磷酰胺（Cy）联合兔抗人胸腺免疫球蛋白（A’rG）；IST组13例治疗方案为：ATG/环孢素A（CsA）。比较两种治疗方法的近期疗效、远期疗效与并发症。结果PBSCT组的中性粒细胞计数、Pt和Hb的恢复时间[分别为（13．5±2．3）、（23．5±4．1）、（82．7±6．1）时决于IST组[分别为（32．6±3．5）、（73．8±6．2）、（296．4±12．5）d]（P〈0．05），但1年的近期疗效比较差异无统计学意义（P〉0．05）。两组3年生存率和总生存率比较差异均无统计学意义（P〉0．05），总复发率比较差异有统计学意SL（P〈0．05）。结论Allo-PBSCT和IST都是治疗SAA的有效手段，但Allo—PBSCT具有造血重建快、复发率低、并发症并没有增加等特点，临床上可作为优先选择。Objective To compare the clinical efficacy and complications of allogeneic peripheral blood stem cell transplantation （Allo-PBSCT） and immunosuppressive therapy （IST） for severe aplastic anemia（ SAA ）. Methods Twenty-five patients with SAA underwent allogeneie HLA-matched sibling donor PBSCT（n = 12） and IST （n = 13 ）. PBSCT group received conditioning regimen of cyclophosphamide（Cy） in combination with antithymocyte globulin （ATG）. IST group received ATG followed by cyclosporine A （CsA）. The short-term and long-term effects and complications were investigated. Results The mean time of recovery, in the absolute neutrophil count（ANC）, platelet and hemoglobin（Hb） in PBSCT group [ （13.5 ± 2.3 ）, （ 23.5 ± 4.1 ）, （82.7 ± 6.1 ） d, respectively ] was shorter than those in IST group [ （ 32.6 ± 3.5 ）, （ 73.8± 6.2 ）, （296.4 ±12.5 ）d, respectively ] and there were statistical differences between two groups（P 〈 0.05 ）. But the one-year treatment effect between two groups showed no difference （P 〉 0.05 ）. There were no statistical differences in 3-year survival and overall survival rate between two groups （P 〉 0.05 ）. However, statistical difference was observed in overall relapse rate （P 〈 0.05 ）. The common complication in two groups was virus infection including cytomegalovirus （CMV） and varicella zoster virus （VZV） ,but there was no statistical difference in the incidence of virus infection between them （P 〉 0.05 ）. Conclusions Both allo-PBSCT and IST are effective methods for treating patients with SAA. PBSCT is considered preferentially in clinic, because of its advantages in faster hematopoietic engraftment, lower relapse rate and no increased complication.

关 键 词：贫血 再生障碍性 造血干细胞移植 移植 同种 免疫抑制法 

分 类 号：R733.71[医药卫生—肿瘤] R556.5[医药卫生—临床医学]