联合免疫抑制治疗小儿重型再障的疗效比较

The Comparison of Therapeutic Effect between Combined Immunosupressive Therapies on Severe Aplastic Anemia in Children

目的观察ATG+CsA为主的免疫抑制剂综合疗法和大剂量甲基泼尼松龙(HDMP)为主的免疫抑制剂治疗对儿童重型再生障碍性贫血(SAA)的疗效及相应免疫功能影响。方法将43例SAA患儿分为两组,其中23例接受ATG为主的免疫抑制综合疗法(Ⅰ组)2,0例接受大剂量甲基泼尼松龙为主的免疫抑制治疗(Ⅱ组)。利用流式细胞仪检测两组患儿治疗后外周血CD3+、CD4+、CD8+等T细胞亚群计数,同时行外周血象及骨髓象检查。结果Ⅰ组23例SAA患儿均缓解,有效率达100%;Ⅱ组20例患儿,有效率55.00%,Ⅰ组总有效率明显高于Ⅱ组(χ2=4.40,P=0.029)。治疗后Ⅰ组血像各主要指标比Ⅱ组的相应指标有明显升高(t=2.31,2.06,2.77,P均<0.05)。治疗后Ⅰ组患儿CD3+、CD4+、CD8+与Ⅱ组相比呈显著性降低,差异有统计学意义(t=4.325,.79,5.41,P均<0.01)。结论联合免疫抑制剂治疗仍是SAA患儿安全、有效的治疗措施,ATG+CsA治疗效果优于HDMP+CsA。

Objective To investigate the influence on immune functions and therapeutic effects in children with severe aplastic anemia who received different combined immunosuppressive therapies （ ATG ＋ CsA or HDMP ＋ CsA）. Methods 43 children with SAA were divided into two groups,group Ⅰ （23 cases） with ATG ＋ CsA,group Ⅱ （20 cases） with HDMP ＋ CsA. Flow cytometry was used to detect the counts of CD3＋ , CD4＋ , CD8＋ from peripheral bloods in the children with severe aplastic anemia. Hemogram and bone marrow smear were used to detect at the same time. Results All 23 children with SAA in the group Ⅰ were received remission,the effective ratio was 100% ;the effective ratio of 20 children with SAA was 55% in the group Ⅱ. The effective ratio of the group Ⅰ was much better that of group Ⅱ （ X2 = 4.40, P = 0.029）. The counts of peripheral bloods WBC, HGB, PLT in group Ⅰ were significantly higher than those of group Ⅱ （ t = 2.31,2.06,2.77, all of them P 〈 0.05 ）. The counts of CD3 ＋ , CD4＋ , CD8＋ of the children in group Ⅰ were obviously lower than those in group Ⅱ. The difference between two groups was significant（ t = 4.32,5.79,5.41, all of them P 〈 0.01 ）. Condusion Combined immunosuppressive therapy was still safe and effective treatment in children with SAA. The therapeutic effect of ATG ＋ CsA was more excellent that of HDMP ＋ CsA.