ATG联合环孢素治疗35例重型再生障碍性贫血患者的疗效分析  

Effect of ATG combined cyclosporine treatment in 35 patients with severe aplastic anemia

作　　者：黄丽芳[1] 毛汉文 孟凡凯[1] 郑邈[1] 孙汉英[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院血液内科,武汉430030 [2]武汉市第五医院血液科

出　　处：《临床血液学杂志》2014年第1期23-25,28,共4页Journal of Clinical Hematology

摘　　要：目的：分析重型再生障碍性贫血（SAA）患者进行抗胸腺细胞球蛋白（ATG）联合环孢素免疫抑制治疗的疗效。方法：回顾性分析ATG联合环孢素治疗35例SAA患者的临床资料,并随访6~88个月,分析联合免疫抑制治疗的疗效及可能的影响因素。结果：使用联合免疫抑制方案治疗SAA的总体有效率为68.6%。对免疫抑制治疗有效的患者,白细胞恢复中位时间为27（12~43）d。获得治愈的8例患者,血小板恢复时间为2~6个月,其余患者血小板未能恢复,其中有7例缓解患者不依赖血小板输注。单因素分析显示,治疗前网织红细胞计数（Ret）高于24×109/L的患者治疗有效率达88.9%,高于Ret〈24×109/L的患者（61.5%）（P〈0.01）;＋30d时中性粒细胞绝对值（ANC）≥1.5×109/L的患者有效率为81.0%,高于ANC〈1.5×109/L的患者（53.8%）（P〈0.05）;SAA患者的有效率为81.0%,优于极重型再障患者的50.0%（P〈0.05）。结论：ATG联合环孢素治疗SAA可有效减少输血依赖,治疗前患者Ret、再障的严重程度分型、＋30d的ANC可能是预测免疫抑制治疗的疗效指标。Objective：To analyze the effect of the ATG combined cyclosporine（CsA）in patients with severe aplastic anemia（SAA）.Method：Clinical data of 35patients with SAA receiving ATG/CsA treatment were retro-spectively analyzed.After follow-up of 6to 88months,the efficacy of immunosuppressive therapy（IST）and the factors that may affect the efficacy were analyzed.Result：The overall effective rate was 68.6%.In patients effective to IST,the median recovery time of white blood cell was 27（12to 43）days.The platelet recovery time in the 8 cured patients was 2to 6months,and the platelet count in the remaining patients failed to rise,of which 7relieved cases didn＇t depend on platelet transfusion.The patients with reticulocte count（Ret）≥24×109/L before treatment had the response rate of 88.9%,which was higher than that with Ret〈24×10^9/L（P〈0.01）.The patients with the neutrophils counts（ANC）≥1.5×10^9/L at＋30day had a higher response rate of 81.0%,which was higher than that with ANC〈1.5×10^9/L（P〈0.05）.SAA patients＇ response rate（81.0%）was higher than that of the VSAA（50.0%）,P0.05.Conclusion：ATG combined with CsA can effectively reduce transfusion dependence on SAA patients.The Ret count,severity of aplastic anemia and the ANC count at＋30day may predict the efficacy of IST treatment.

关 键 词：贫血 再生障碍性 免疫抑制治疗 疗效分析 

分 类 号：R556.5[医药卫生—血液循环系统疾病]