ATG联合CsA治疗重型再生障碍性贫血的效果  

EFFECTIVENESS OF ATG PLUS CsA IN THE TREATMENT OF SEVERE APLASTIC ANEMIA

作　　者：孟令弟[1] 崔中光[1] 史雪[1] 许宏[1] 赵洪国[1] 赵春亭[1] 

机构地区：[1]青岛大学附属医院血液内科,山东青岛266003

出　　处：《青岛大学医学院学报》2015年第4期387-389,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨抗胸腺细胞球蛋白(ATG)联合环孢素A(CsA)治疗重型再生障碍性贫血(SAA)的效果。方法回顾性分析使用ATG联合CsA治疗的27例SAA病人的临床资料,观察治疗的效果。结果 27例SAA病人治疗总体有效率达70.3%。年龄≤18岁的病人较>18岁者疗效好(Z=2.219,P<0.05);性别及是否联用雄激素对疗效没有影响,且联用雄激素组病人的谷丙转氨酶及谷草转氨酶明显高于未联用组(t=3.657、2.947,P<0.05)。获得重组人粒系集落刺激因子(G-CSF)治疗反应组较无反应组疗效好(Z=3.436,P<0.05)。SAA组的有效率高于极重型再生障碍性贫血(VSAA)组(Z=2.320,P<0.05)。治疗过程中主要不良反应为低清蛋白血症、发热、胸闷、憋气、心律失常、皮疹、全身肌肉酸痛、肝肾功能损害。在20例感染的病人中6例确诊为真菌感染。结论ATG联合CsA治疗SAA临床疗效显著,联用雄激素可增加肝功能损害的风险,应慎用。获得G-CSF治疗反应的病人预后好,VSAA者预后不佳,ATG治疗过程中出现的不良反应可获得较好控制。Objective To assess the efficacy of antithymocyte globulin（ATG）plus ciclosporin A（CsA）in the treatment of patients with severe aplastic anemia（SAA）. Methods Clinical date of 27 patients with SAA treated with ATG plus CsA were reviewed retrospectively for therapeutic outcome. Results The overall effective rate of the 27 patients was 70.3%,the result was better in those of 18 years old or younger than those over 18（Z=2.219,P0.05）.Gender and whether or not using androgen had no effect on the effectiveness.The levels of ALT and AST in patients treated with combined androgen were significantly higher than that in patients without（t=3.657,2.947;P0.05）.Patients with neutrophil response to G-CSF treatment had a higher response rate than those without-92.9% versus 46.2%（Z=3.436,P0.05）.The therapeutic response rate in SAA patients was higher than that in VSAA-86.7% versus 50.0%（Z=2.320,P0.05）.Main adverse reactions seen in the process of treatment were hypoalbuminemia,fever,bosom frowsty,breathlessness,arrhythmia,skin rash,systemic muscular soreness,damage of liver and kidney functions.Of the 20 infected patients,six were diagnosed with fungal infection. Conclusion Cotherapy of antithymocyte globulin and ciclosporin A for severe aplastic anemia is effective,combined with androgen can increase the risk of liver damage,it should be used with caution.The prognosis of patients with neutrophil response to G-CSF treatment is good,that of VSAA patients is poor.The adverse reactions of antithymocyte globulin in the process of treatment can be well controlled.

关 键 词：抗淋巴细胞血清 环孢素A 贫血 再生障碍性 治疗结果 

分 类 号：R556.5[医药卫生—血液循环系统疾病]