序贯强化免疫抑制并用造血生长因子治疗重型再生障碍性贫血  

Sequential intensified immunosuppressive therapy combining with hematopoietic growth factors in the treatment of severe aplastic anemia

作　　者：何广胜[1] 邵宗鸿[1] 张益枝[1] 刘鸿[1] 李克[1] 宋鲁燕[1] 郑以洲[1] 陈桂彬[1] 和虹[1] 赵明峰[1] 施均[1] 张泓[1] 储榆林[1] 钱林生[1] 杨天楹[1] 杨崇礼[1] 

机构地区：[1]中国医学科学院,中国协和医科大学血液学研究所,血液病医院,天津300020

出　　处：《中华血液学杂志》2001年第4期177-181,共5页Chinese Journal of Hematology

基　　金：卫生部基金资助项目!( 96 2 10 7)

摘　　要：目的　探寻降低重型再生障碍性贫血 (SAA)患者早期死亡率并提高疗效的方法。方法　采用前瞻性同期对照研究法 ,比较仅用抗淋巴细胞球蛋白 /抗胸腺细胞球蛋白 (ALG/ATG)和环孢菌素A(CsA)序贯强化免疫抑制治疗 (SIIST) (36例 )与SIIST联合造血生长因子 (HGF) (37例 ) ,即并用粒 巨噬细胞集落刺激因子 (GM CSF)、红细胞生成素 (Epo)或粒细胞集落刺激因子 (G CSF)、Epo治疗SAA的疗效。结果　SIIST联合HGF治疗组和单用SIIST组比较不仅早期感染率 (分别为 2 4.3%和5 5 3% )、死亡率 (分别为 4.0 %和 16 .7% )有所降低 ,有效率 (分别为 89.2 %和 6 3.9% )有所提高 ,而且血常规、骨髓象恢复速度加快 ,成分输血脱离时间及骨髓造血祖细胞体外培养均优于SIIST组。两种不同HGF方案治疗组之间未见明显区别 ,均耐受良好。结论　在ALG/ATG和CsA强化免疫抑制的基础上联合HGF治疗SAA ,可降低早期死亡率、感染率 ,并获得较高的疗效。Objective To explore more effective regimen for reducing early mortality of severe aplastic anemia (SAA) and improving therapeutic effectiveness. Methods Antilymphocyte globulin/antithymocyte globulin (ALG/ATG) and cyclosporine A(CsA) (sequential intensified immunosuppressive therapy, SIIST),with or without hematopoietic growth factors (HGFs) were administered to 73 SAA patients in a prospective randomized clinical trial to test the effectiveness of the addition of HGFs for the patients. Results The response rate of SIIST with HGFs group was significantly higher than that of SIIST alone group(89.2% vs 63.9%),with lower rates of early infection (24.3% vs 55.3%)and mortality(4.0% vs 16.7%),shorter duration of cytopenia and blood transfusion dependence and faster recovery of bone marrow hematopoiesis. The addition of HGFs to SIIST was tolerated well in all patients.There was no difference in the treatment outcome of the two groups with GM CSF plus Epo or G CSF plus Epo. Conclusion The use of HGFs in combination with SIIST could reduce early infection and mortality rates and, therefore, improve the response rates in SAA patients.

关 键 词：再生障碍性贫血 环孢菌素A 造血生长因子 治疗 强化免疫抑制 

分 类 号：R556.5[医药卫生—血液循环系统疾病]