猪抗人淋巴细胞球蛋白治疗重型再生障碍性贫血的临床研究

摘要

Objective To analyze the efficacy and side effects of combination of pig antithymecyte globulin(ALG)and cyclosporine A(CsA)as the first-line immunesuppressive therapy(IST)for adult severe aplastic anemia(SAA).Methods The efficacy,complications,therapeutic response relevant factors were analysed for thirty-six adult SAA patients treated with pig ALG and CsA in our hospital.Results Of thirty-six patients,four died.The median time of the white blood cell recovery,to transfusion of red blood cell independent,and to transfusion of palete independent was 30,55 and 60 days respectively.The overall response rate of one year was 86.2%.The 2-year overall response was 91.7%,and the overall response rate for a year was not related to sex,age,subtypes,and the ratio of CD8(P >0.05).Patients with course of disease less than three months or peripheral blood absolute neutrophil count(ANC)≥0.2 ×109 /L had a higher response rate.The response rate was close to horse or rabbit ATG for SAA as reported in our country, Europe and United States,but with less side effects and only 1 /3-1 /2 expense.Conclusion Pig-ALG in combination with CsA first-line for adult severe aplastic anemia leads to excellent treatment outcomes with minor side effects.%目的：探讨一线应用猪抗人淋巴细胞球蛋白（P-ALG）联合环孢素（CsA）治疗重型再生障碍性贫血（SAA）的疗效及不良反应。方法回顾性分析我科应用 P-ALG 联合 CsA 治疗36例 SAA 患者的疗效、并发症及转归，并对患者的年龄、疾病严重程度、发病距应用 P-ALG 的时间等因素与疗效进行相关分析。结果36例患者中死亡4例，白细胞恢复中位时间为30天，脱离红细胞输注的中位时间为55天，脱离血小板输注的中位时间为60天。1年总有效率为86．2％，2年总有效率达91．7％，1年总有效率与性别、年龄、疾病分型、CD8比例无明显相关（P ＞0．05），病程＜3个月及外周血中性粒细胞（ANC）≥0．2×109／L 患者的有效率高；与国内及欧美国家报道的利用马或兔抗胸腺细胞球蛋白（ATG）治疗 SAA 的有效率相当，而不良反应小，花费仅为马或兔 ATG 治疗的1／3～1／2。结论应用 P-ALG 联合 CsA 治疗重型再生障碍性贫血疗效显著，不良反应轻微。