中药联合免疫抑制剂治疗重型再生障碍性贫血临床研究

Clinical Observation on Herbal Medicine Combined with Immunosuppressive Agents for the Treatment of Severs Aplastic Anemia

目的:观察补肾凉血中药联合强烈免疫抑制剂治疗重型再生障碍性贫血(SAA)的临床疗效。方法: 11例患者采用补肾凉血中药联合抗胸腺细胞球蛋白(ATG)、环孢素A(CSA)治疗。治疗每1～2天查血常规及网织红细胞(Ret)1次,此后根据情况每周1～2次;CSA浓度开始每周查1次,稳定后1月查1次;3月、6月时全面复查血象、骨髓象、溶血等,以后每3月复查。结果:随诊1年以上7例,基本治愈3例,缓解、明显进步各1例,无效1例,1例患者免疫治疗后15天因颅内出血死亡;另4例治疗未达1年,其中2例明显进步, 1例缓解,1例无效。总有效率为72.73%。治疗前后白细胞(WBC)、Ret、血红蛋白(Hb)均较治疗前显著改善,差异有显著性意义(P<0.05)。血小板(BPC)亦较治疗前有明显提升,但差异无显著性意义(P>0.05)。有效病例于1～2月血象开始改善,多数先为Ret上升,继之Hb上升,随后WBC上升,BPC上升最晚亦最慢。治疗前所有患者均行多部位穿刺,除2例骨髓增生尚活跃外余均增生减低或重度减低;治疗后3月骨髓增生为活跃或明显活跃者5例,增生低下者6例;6月后骨髓增生为活跃或明显活跃者8例,增生低下者3例。结论:补肾凉血中药联合ATG、CSA治疗SAA,可明显改善症状、调节免疫、增强患者的抗病能力、减少强烈免疫抑制剂的不良反应、延长输血间歇期。

Objective:To observe the therapeutic effect of kidney-tonifying and blood-cooling herbal medicine combined with immunosuppressive agents for the treatment of severe aplastic anemia(SAA).Methods:Atl the patients received kidney-tonifying and blood-cooling herbal medicine combined with immunosuppressive agents of ATG and CSA.At the beginning of the treatment, blood routine and reticulocyte(Ret)count were carnied out every 1～2 days and then once of twice for each week.The concentration of CSA was detected once per week,and then once per month when the illness became ateady.After treatment for 3 and 6 months,hemogram,myelogram and hemolysis were examined,and then were reexamined every 3 months.Reeults:Of 7 patients followed-up for over one year,3 were cured basically,1 relieved,1 improved and 1 ineffective, One patient died of intracranial hemorrhage after treatment with immunosuppressive agents for 15 days.Of 4 patients receiving treatment less than one year,2 were much improved,1 relieved and 1 ineffective,the total effective rate being 72.7%.The white blood cell(WBC)and Ret count and hemoglobin level were much improved after treatment(P<0.05 compared with those before treatment). Blood Platelet Count(BPC)level was also increased,but the difference was insignificant(P>0.05 compared with those before treatment).Hemogram in effective patients was improved after treatment for 1-2 months,manifested as that Ret was increased firstly,then HB,and WBC came next,finally BPC was increased.The results of myelogram examination showed that marrow hyperplasis was active only in 2 patients after treatment for 1-2 months;after treatment for 3 months, marrow hyperplasis was active in 5 patients and low in 6 patients;after treatment for 6 months, marrow hyperplasis was active in 8 patients and low in 3 patients.Conclusion:Kidney-tonifying and blood-cooling herbal medicine combined with immunosuppreasive agents of ATG and CSA was effective for the treatment of SAA throuth relieving symptoms,regulation immune function,increasing body resistance,reducing adverse actions and prolonging intermission of blood transfusion.