免疫抑制剂治疗重型再生障碍性贫血患儿的临床效果  

Effect of immunosuppressive therapy on severe aplastic anemia in children

作　　者：赵雪莲[1] 王西阁[1] 宋丽丽[1] 梁宇[1] 李四保[1] 臧文涛 ZHAO Xuelian;WANG Xige;SONG Lili;LIANG Yu;LI Sibao;ZANG Wentao(Department of Pediatrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院儿内科

出　　处：《中华实用诊断与治疗杂志》2019年第11期1117-1119,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技厅重点研发与推广专项（182102311198）

摘　　要：目的探讨抗胸腺细胞球蛋白(antithymocyte globulin,ATG)联合环孢菌素A(cyclosporinem,CsA)治疗儿童重型再生障碍性贫血(severe aplastic anemia,SAA)的临床疗效及对患儿免疫功能的影响。方法66例SAA患儿,46例采用ATG联合CsA治疗者为观察组,20例应用CsA治疗者为对照组。比较2组治疗前,治疗3、6、12个月免疫功能,分别于治疗3、6、12个月评定治疗效果,并记录治疗期间不良反应发生率及病死率。结果观察组治疗3、6、12个月缓解率(65.22%、69.56%、73.91%)高于对照组(35.00%、40.00%、45.00%)(P<0.05);观察组治疗3、6、12个月CD8^+T淋巴细胞比率[(33.26±3.25)%、(28.15±3.24)%、(23.15±4.69)%]、IgG水平[(8.22±3.69)、(7.25±2.85)、(6.25±2.45)g/L]低于对照组[CD8^+T淋巴细胞比率:(39.45±2.58)%、(32.64±1.58)%、(30.16±2.45)%;IgG:(9.68±4.12)、(8.63±2.15)、(8.05±1.23)g/L],CD4^+/CD8^+(0.77±0.15、1.15±0.13、1.78±0.22)、IgA水平[(1.25±0.34)、(1.36±0.25)、(1.62±0.48)g/L]高于对照组[CD4^+/CD8^+:0.67±0.22、0.86±0.15、1.06±2.36;IgA:(1.22±0.16)、(1.28±0.26)、(1.45±0.36)g/L](P<0.05);观察组治疗6、12个月CD3^+T淋巴细胞比率[(76.18±4.69)%、(78.59±6.58)%]、CD4^+T淋巴细胞比率[(32.36±5.12)%、(41.25±4.25)%]高于对照组[CD3^+T淋巴细胞比率:(74.56±2.36)、(75.69±3.58)%;CD4^+T淋巴细胞比率:(28.46±2.58)%、(32.15±4.26)%](P<0.05);观察组治疗12个月不良反应发生率(56.25%)高于对照组(5.00%)(P<0.05),病死率(17.39%)与对照组(25.00%)比较差异无统计学意义(P>0.05)。结论ATG联合CsA治疗可改善SAA患儿免疫功能,其临床效果明显优于单纯CsA治疗。Objective To explore the effect of antithymocyte globulin(ATG)combined with cyclosporine A(CsA)on severe aplastic anemia(SAA)in children,and influence on immune function.Methods In 66 children with SAA,46 patients received ATG+CsA(observation group)and 20 patients received CsA(control group).The immune indexes were compared before and 3,6 and 12 months after treatment between two groups,the therapeutic effect was evaluated in 3,6 and 12 months after treatment,and the incidence of adverse reaction and the fatality were recorded.Results In 3,6 and 12 months after treatment,the response rates were significantly higher in observation group(65.22%,69.56%,73.91%)than those in control group(35.00%,40.00%,45.00%)(P<0.05),the percentages of CD8^+T cell((33.26±3.25)%,(28.15±3.24)%,(23.15±4.69)%)and IgG((8.22±3.69),(7.25±2.85),(6.25±2.45)g/L)were lower than those in control group((39.45±2.58)%,(32.64±1.58)%,(30.16±2.45)%;(9.68±4.12),(8.63±2.15),(8.05±1.23)g/L)(P<0.05),and the levels of CD4^+/CD8^+(0.77±0.15,1.15±0.13,1.78±0.22)and IgA((1.25±0.34),(1.36±0.25),(1.62±0.48)g/L)in observation group were higher than those in control group(0.67±0.22,0.86±0.15,1.06±2.36;(1.22±0.16),(1.28±0.26),(1.45±0.36)g/L)(P<0.05).In 6 and 12 months after treatment,the percentages of CD3^+T cell((76.18±4.69)%,(78.59±6.58)%)and CD4^+T cell((32.36±5.12)%,(41.25±4.25)%)in observation group were higher than those in control group((74.56±2.36)%,(75.69±3.58)%;(28.46±2.58)%,(32.15±4.26)%)(P<0.05).The incidence of adverse reactions in 12 months after treatment was higher in observation group(56.25%)than that in control group(5.00%)(P<0.05),and the fatality showed no significant difference between observation group(17.39%)and control group(25.00%)(P>0.05).Conclusion ATG+CsA can improve the immune function in children with SAA,with better effect than CsA.

关 键 词：重型再生障碍性贫血 抗胸腺细胞球蛋白 环孢菌素A 儿童 免疫功能 

分 类 号：R73[医药卫生—肿瘤]