N-乙酰半胱氨酸对重型再生障碍性贫血患者异基因造血干细胞移植后血小板恢复的影响  

Effect of N-acetylcysteine on platelet recovery after allogeneic hematopoietic stem cell transplantation in patients with severe aplastic anemia

作　　者：张江召 刘敏[1] 黄知平[1] 唐元艳[1] ZHANG Jiangzhao;LIU Min;HUANG Zhiping;TANG Yuanyan(Department of Hematology,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou Hubei 434020,China)

机构地区：[1]长江大学附属荆州医院血液内科,湖北荆州434020

出　　处：《新疆医科大学学报》2023年第8期1032-1036,共5页Journal of Xinjiang Medical University

基　　金：湖北省健康委员会2019-2020科研立项面上项目(WJ2019M081)。

摘　　要：目的探讨N-乙酰半胱氨酸对重型再生障碍性贫血(Severe aplastic anemia,SAA)患者异基因造血干细胞移植(Allogeneic hematopoietic stem cell transplantation,allo-HSCT)后血小板恢复的影响。方法纳入接受allo-HSCT治疗的62例SAA患者,其中31例接受allo-HSCT后进行N-乙酰半胱氨酸治疗(N-乙酰半胱氨酸组),31例未进行N-乙酰半胱氨酸治疗(对照组)。比较两组患者一般资料、治疗效果及不良反应。结果两组患者一般资料无显著性差异,具有可比性。与对照组相比,N-乙酰半胱氨酸组患者≥50×109/L、≥100×109/L的血小板恢复时间更短,骨髓巨核细胞多,血小板输注量更少(P均<0.05)。对照组患者有14例(45.2%)出现不良反应,而N-乙酰半胱氨酸组仅有3例(9.7%)患者出现不良反应。通过逐步回归模型分析可见,血小板计数恢复至100×109/L之前应用可能影响血小板恢复的药物及是否使用N-乙酰半胱氨酸是影响血小板恢复时间的主要因素(P均<0.05)。3年随访发现两组患者生存率差异无统计学意义(P=0.498)。结论N-乙酰半胱氨酸能促进SAA患者allo-HSCT治疗后血小板恢复、减少血小板输注量。Objective To investigate the effects of N-acetylcysteine on platelet recovery in patients with severe aplastic anemia(SAA)undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT).MethodsA total of 62 SAA patients who received allo-HSCT were included,with 31 patients receiving N-acetylcysteine treatment after allo-HSCT(N-acetylcysteine group)and 31 patients without N-acetylcysteine treatment(control group).General information,treatment outcomes and adverse reactions were compared between the two groups.ResultsThere were no significant differences in general information between the two groups,indicating comparability.Compared with the control group,the patients in N-acetylcysteine group had a shorter time to platelet recovery(≥50×10\+9/L,≥100×10\+9/L),more bone marrow megakaryocytes and required fewer platelet transfusions(all P<0.05).Adverse reactions occurred in 14 patients(45.2%)in control group,while only 3 patients(9.7%)in N-acetylcysteine group experienced adverse reactions.Stepwise regression analysis revealed that the use of drugs may affect platelet recovery before platelet count reaches 100×10\+9/L and the use of N-acetylcysteine was the main factor affecting platelet recovery time(all P<0.05).A 3-year follow-up showed no significant difference in survival rates between the two groups(P=0.498).ConclusionN-acetylcysteine promotes platelet recovery and reduces platelet transfusion requirements in SAA patients after allo-HSCT.

关 键 词：再生障碍性贫血 异基因造血干细胞移植 N-乙酰半胱氨酸 血小板 

分 类 号：R457.1[医药卫生—治疗学]