抗淋巴细胞球蛋白治疗再生障碍性贫血的疗效及不良反应

Therapeutic Effect and Side-Effects of Antilymphocyte Globulin on Aplastic Anemia in Children

目的探讨抗淋巴细胞球蛋白（ALG）治疗再生障碍性贫血（AA）的疗效。分析ALG不良反应的特点和防治方法。方法对2002年4月-2009年10月本院收治的162例诊断为AA并接受ALG治疗的患儿的临床资料进行回顾性分析,共154例完成了ALG疗程。其中极重型AA（VSAA）34例,重型AAⅠ型（SAAⅠ）103例,重型AAⅡ型（SAAⅡ）7例,中型AA（MAA）10例。结果 154例中,基本治愈62例（40.3%）,缓解15例（9.7%）,进步28例（18.2%）,无效或死亡23例（14.9%）,失访26例（16.9%）,总有效率为68.2%,复发8例（5.2%）。63例出现变态反应,主要表现为发热和皮疹等。发生时间为用药1-5 d,持续1-4 d。8例因严重变态反应而停止使用ALG,其中1例死于严重的全身血管性变态反应。81例出现血清病反应,主要表现为发热、皮疹和关节肿痛等。发生时间为ALG治疗结束2-14 d,持续1-12 d。有无血清病与ALG疗效差异无统计学意义（P〉0.05）。患儿性别、年龄、CD4/CD8、人白细胞Dr抗原与血清病发生率的差异均无统计学意义（Pa〉0.05）。结论 ALG治疗AA疗效肯定,变态反应和血清病为治疗中常见的不良反应,应用甲泼尼龙可较好地控制过敏和血清病症状。

Objective To explore the therapeutic effect of antilymphocyte globulin（ALG） on aplastic anemia（AA） in children and analyze its characteristics of side-effects and the methods of prevention and treatment.Methods The clinical data of 162 children with AA who received ALG treatment from Apr.2002 to Oct.2009 were analyzed retrospectively.Of which 154 children of them[severe aplastic anemia（SAA）Ⅰ 103 cases,very severe aplastic anemia（VSAA） 34 cases,SAAⅡ 7 cases,moderately aplastic anemia（MAA） 10 cases] received ALG treatment completely.Results Of the 154 children,62 cases were nearly cured（40.3%）,15 cases were relieved（9.7%）,28 cases were improved（18.2%）,23 cases were nonresponsive or died（14.9%）,26 cases were loss of follow up（16.9%）,the overall effective rate was 68.2%,8 cases were relapses（5.2%）.Clinical evidence of allergy developed in 63 cases with fever,anthema and so on.Allergy occurred 1-5 days after ALG administration and lasted for 1-4 days.Eight cases gave up ALG treatment because of severe allergy,of which 1 child died of severe systemic vascular allergy.Clinical evidence of serum sickness developed in 81 children with fever,anthema,arthralgia and so on.Serum sickness occurred 2-14 days after ALG treatment and lasted for 1-12 days.There was no significant difference about the response to ALG therapy between the children with serum sickness and without（P0.05）.There was no significant difference about the incidence of serum sickness between children′s sex,age,CD4/CD8 and human leucocyte antigen Dr（Pa0.05）.Conclusions ALG therapy for child is effective.Allergy and serum sickness are common complications in children with AA following ALG therapy and can be improved by methylprednisolone application.