网织红细胞计数在以补肾中药为主联合ATG/ALG治疗重型再生障碍性贫血中的预测作用  

Predictive Role of Reticulocyte Count in the Treatment of Severe Aplastic Anemia with Kidney-Tonifying Chinese Medicianl Herbs Combined with ATG/ALG

作　　者：唐旭东[1] 刘锋[1] 李柳[1] 刘驰[1] 肖海燕[1] 张姗姗[1] 杨秀鹏[1] 王洪志[1] 郭晓青 全日城[1] 胡晓梅[1] 麻柔[1] TANG Xu-dong;LIU Feng;LI Liu;LIU Chi;XIAO Hai-yan;ZHANG Shan-shan;YANG Xiu-peng;WANG Hong-zhi;GUO Xiao-qing;QUAN Ri-cheng;HU Xiao-mei;MA Rou(Xiyuan Hospital of Chinese Academy of Chinese Medical Sciences,Beijing,China,100000)

机构地区：[1]中国中医科学院西苑医院,北京100000

出　　处：《河南中医》2018年第10期1546-1551,共6页Henan Traditional Chinese Medicine

摘　　要：目的:探讨网织红细胞计数在以补肾中药为主联合抗胸腺细胞球蛋白(antithymocyte globulin,ATG)/抗淋巴细胞球蛋白(antilymphocyte globulin,ALG)治疗重型再生障碍性贫血(以下简称为重型再障)中的预测作用。方法:选取1992年1月至2016年5月在西苑医院血液科病房住院治疗的重型再障患者151例,有11例不能评价疗效,6例在ATG/ALG治疗前有严重感染,治疗后1个月内死亡,5例在ATG/ALG治疗后立即出院,随后失访,所以,实际可随访的有效病例140例。所有患者治疗上以补肾中药为主联合ALG/ATG,并后期辅以环孢霉素A、雄性激素和造血生长因子等治疗。结果:140例患者中,治愈37例,缓解35例,进步44例,无效24例,有效率83. 1%;补肾中药联合ATG/ALG治疗前,20~40岁患者的网织红细胞计数10×109L-1,其疗效较好(P=0. 025),而20岁以下、40~60岁、60岁以上患者均无明显差异(P=0. 368,P=0. 323,P=0. 395);以补肾中药为主联合ATG/ALG治疗后1个月、2个月、3个月和6个月,网织红细胞计数10×109L-1的患者疗效更显著(P=0. 003,P=0. 006,P=0. 001,P=0. 035);补肾中药联合ATG/ALG治疗后1~6个月,网织红细胞计数10×109L-1~20×109L-1和20×109L-1组的1年、3年、5年和10年的累积生存率明显优于网织红细胞计数<10×109L-1(P=0. 007,P=0. 023,P=0. 002,P=0. 002);治疗后2个月和3个月,网织红细胞计数10×109L-1~20×109L-1的累积生存率最高,其1年、3年、5年和10年的累积生存率皆为100%、100%、100%和100%;治疗后6个月,网织红细胞计数10×109L-1~20×109L-1的累积生存率较高,网织红细胞计数20×109L-1的累积生存率最高,其1年、3年、5年和10年的累积生存率皆为100%,96. 0%,89. 1%和89. 1%。结论:网织红细胞计数在以补肾中药为主ATG/ALG治疗重型再障的治疗前和治疗过程中,应该是一个具有潜力的早期预测临床疗效、预估患者累积生存率的有效指标。Objective： To investigate the predictive role of reticulocyte count in the treatment of severe aplastic anemia（SAA） with kidney-tonifying Chinese medicianl herbs combined with antithymocyte globulin（ATG）/antilymphocyte globulin（ALG）. Methods： One hundred and fifty-one patients with SAA who were hospitalized in the blood ward of Xiyuan Hospital From January 1992 to May 2016 were selected. Among them,11 patients＇ curative effect could not be evaluated; 6 patients had severe infection before ATG/ALG treatment,and died within one month after the treatment; 5 patients were discharged immediately after ATG/ALG treatment,and were subsequently lost to follow-up. Therefore,140 effective cases could be followed up.. All patients were treated mainly with kidney-tonifying Chinese medicianl herbs combined with ALG/ATG,and later with cyclosporine A,androgen and hematopoietic growth factor. Results： Among 140 cases,37 were cured,35 were relieved,44 were progressive,24 were ineffective,and the effective rate was 83. 1%. Reticulocyte counts of patients aged 20-40 years old were or more than 10 × 109 L-1 before the treatment of kidney-tonifying Chinese medicianl herbs combined with ATG/ALG. The curative effect was better（P = 0. 025）,but there was no significant difference between patients aged under 20,40-60 and over 60 years old（P = 0. 368,0. 323,0. 395）. One month,two months,three months and six months after the treatment,the effect of reticulocyte count which were or more than 10 × 109 L-1 of the patients was more significant（P = 0. 003,0. 006,0. 001,0. 035）. The cumulative survival rates of 1 year,3 years,5 years and 10 years in the group with reticulocyte count 310 and 20 × 109 L-1 and 20 × 109 L-1 were significantly better than those in the group with reticulocyte count 10 × 109 L-1（P = 0. 007,0. 023,0. 002,0. 002）. Two months and 3 months after the treatment,the cumulative survival rate of reticulocyte count 10 × 109 L-1-20 × 109 L-1 was the highest. The cumulative survival rates o

关 键 词：重型再生障碍性贫血 补肾中药 抗胸腺细胞球蛋白 抗淋巴细胞球蛋白 网织红细胞计数 

分 类 号：R259.565[医药卫生—中西医结合]