按需糖皮质激素治疗对再生障碍性贫血p-ALG治疗相关血清病反应发生及转归的影响  

The effect of on-demand glucocorticoid strategy on the occurrence and outcome of p-ALG-associated serum sickness in aplastic anemia

作　　者：杨夏婉 周康 李建平 樊慧慧 杨文睿 叶蕾 李园 李洋 彭广新 杨洋 熊佑祯 赵馨 井丽萍 张莉 张凤奎 Yang Xiawan;Zhou Kang;Li Jianping;Fan Huihui;Yang Wenrui;Ye Lei;Li Yuan;Li Yang;Peng Guangxin;Yang Yang;Xiong Youzhen;Zhao Xin;Jing Liping;Zhang Li;Zhang Fengkui(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津300020

出　　处：《中华血液学杂志》2023年第3期211-215,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金(81900127);中国医学科学院中央级公益性科研院所基本科研业务费专项资金资助项目(2020-RW310-002)。

摘　　要：目的探讨按需糖皮质激素治疗对再生障碍性贫血(AA)应用猪抗人淋巴细胞球蛋白(p-ALG)相关血清病反应发生及转归的影响。方法收集2019年1月至2022年1月连续就诊于中国医学科学院血液病医院贫血诊疗中心接受p-ALG治疗的AA患者资料,其中按需治疗组患者根据血清病反应发生与否及严重程度应用糖皮质激素,共35例;传统防治组患者从同期接受常规糖皮质激素防治方案的群体中依据年龄、疾病诊断分型按1∶3进行倾向性评分匹配,共纳入105例。比较两组间血清病发生率、临床表现、治疗转归及糖皮质激素用量。结果按需治疗组和传统防治组患者的血清病发生率分别为65.7%和54.3%,差异无统计学意义(P=0.237)。两组患者血清病中位发病时间相同[第12(9,13)天对第12(10,13)天,P=0.552];临床症状体征相似,主要表现为关节和(或)肌肉疼痛、发热及皮疹;严重程度分级均以1~2级血清病反应为主(62.8%对51.4%),仅少数3级反应(2.9%对2.9%),无4级和5级血清病反应,不同等级血清病反应在两组间分布差异无统计学意义(P=0.530);血清病中位持续时间相同[5(3,7)d对5(3,6)d,P=0.529],均经糖皮质激素治疗后完全缓解。在未发生血清病反应的患者中,传统防治组平均每例患者的糖皮质激素预防量为(469.48±193.57)mg(按需治疗组预防量为0)。在发生血清病反应的患者中,按需治疗组平均每例患者的糖皮质激素治疗量显著少于传统防治组[(125.91±77.70)mg对(653.90±285.56)mg,P<0.001]。结论按需治疗策略可显著减少糖皮质激素用量,而并不增加血清病发生率,血清病持续时间和2级以上血清病反应发生率较传统防治组患者相近。Objective To investigate the effect of on-demand glucocorticoid strategy on the occurrence and outcome of porcine anti-lymphocyte globulin(p-ALG)-associated serum sickness in aplastic anemia(AA).Methods The data of AA patients who received in the Anemia Diagnosis and Treatment Center of Haematology Hospital,CAMS&PUMC from January 2019 to January 2022 were collected.Among them,35 patients were enrolled in the on-demand group,with the glucocorticoid strategy adjusted based on the occurrence and severity of serum sickness;105 patients were recruited in the usual group by matching the age and disease diagnosis according to 1∶3 ratio in patients who received a conventional glucocorticoid strategy in the same period.The incidences,clinical manifestations,treatment outcomes of serum sickness,and glucocorticoid dosage between the two groups were analyzed.Results The incidences of serum sickness in the on-demand group and the usual group were 65.7%and 54.3%(P=0.237),respectively.The median onset of serum sickness was the same[12(9,13)d vs the 12(10,13)d,P=0.552],and clinical symptoms and signs,primarily joint,and/or muscle pain,fever,and rash were similar.Severity grades were both dominated by Grades 1-2(62.8%vs 51.4%),with only a few Grade 3(2.9%vs 2.9%),and no Grades 4-5.No significant difference in the serum sickness distribution(P=0.530).The median duration of serum sickness was the same[5(3,7)d vs 5(3,6)d,P=0.529],and all patients were completely cured after glucocorticoid therapy.In patients without serum sickness,the average dosage of prophylactic glucocorticoid per patient in the usual group was(469.48±193.57)mg(0 in the on-demand group).When compared to the usual group,the average therapeutic glucocorticoid dosage per patient in the on-demand group was significantly lower[(125.91±77.70)mg vs(653.90±285.56)mg,P<0.001].Conclusions In comparison to the usual glucocorticoid strategy,the on-demand treatment strategy could significantly reduce glucocorticoid dosage without increasing the incidence of serum sicknes

关 键 词：贫血 再生障碍性 血清病 糖皮质激素 

分 类 号：R556.5[医药卫生—血液循环系统疾病]