摘要
目的:分析重型再生障碍性贫血(再障)患者采用ATG和环孢素联合免疫抑制治疗(IST)的疗效。方法:回顾性分析使用IST的24例重型再障患者临床资料,并随访8～79个月,分析IST的疗效及可能影响疗效的因素。结果:使用IST方案总体有效率达75.0%。对IST治疗有效的患者,白细胞恢复时间为15～42d,中位恢复时间为24d。获得治愈的6例患者,血小板恢复时间为2～6个月。合用雄激素的患者治疗反应率为82.4%,高于未合用雄激素患者的57.1%。+30d时中性粒细胞绝对值(N)≥1.5×109/L的患者有效率为86.7%,N<1.5×109/L患者的有效率为50.0%。有18例患者拟诊为真菌感染,1例合并浸润性肺结核。+30d时N<1.5×109/L的8例患者均出现典型的肺部真菌感染灶。结论:IST可有效减少输血依赖。合用雄激素可增加治疗反应率;治疗+30d中性粒细胞绝对值≥1.5×109/L可能提示患者对IST反应好。中性粒细胞减少时间长的患者,感染发生率高,尤其是真菌感染。
Objective： To analyze the therapeutic effect of combined immunosuppressive therapy （ IST） （ ATG combined with cyclosporine） in treatment of patients with severe aplastic anemia. Methods： Clinical data of 24 patients with severe aplastic anemia were analyzed retrospectively,and were followed-up for 8 to 79 months. Therapeutic effects of IST as well as the factors that might influence the efficacy were analyzed. Results： The overall effective rate of standard IST was 75. 0% . In patients who responsed to IST,the recovery time of white blood cell was 15 ～ 42 days,the median recovery time was 24 days. The platelet recovery time was 2 ～ 6 months in 6 cured patients. The response rate in patients with com- bined androgen treatment was 82. 4% ,higher than that in patients without androgen （ 57. 1% ） . The response of rate patients with the neutrophilic counts （ N） ≥1. 5 × 109 /L at ＋ 30 day （ was 86. 7% ） and 50. 0% in patients with N ﹤ 1. 5 × 109 /L （ 50. 0% ） . 18 patients were suspected with fungal infection,1 case complicated with infiltrative pulmonary tuberculosis. 8 patients with N ﹤ 1. 5 × 109 /L showed typical pulmonary fungal infection foci. Conclusions： IST could effectively reduce transfusion dependence; when combined with androgen IST can increase the response rate. Neutrophilic counts more than 1. 5 × 109 /L at ＋ 30 day may indicate a good response to IST. Patients with neutropenia for a long time have a higher incidence of fungal infection.
出处
《内科急危重症杂志》
2011年第6期348-350,共3页
Journal of Critical Care In Internal Medicine
