ATG联合环孢素A治疗重型再生障碍性贫血近期疗效分析

Analysis on short-term effect of ATG combined with CsA therapy in severe aplastic anemia

目的：分析抗人胸腺球蛋白（ATG）联合环孢素A（CsA）治疗重型再生障碍性贫血（SAA）患者的近期疗效以及不良反应,为SAA的治疗提供依据。方法：选择2009年12月—2011年5月于本中心接受ATG联合CsA治疗的SAA患者15例,观察治疗后患者临床表现的改善、外周血象的变化及用药期间不良反应的发生率等情况。结果：15例患者中,达到疗效评估时间者共10例,其中完全缓解4例（40.0%）,部分缓解4例（40.0%）,无效1例（10.0%）,死亡1例（10.0%）,近期总有效率为80.0%。患者血象在ATG治疗后1-2个月开始逐渐改善,首先出现白细胞及中性粒细胞的回升,血红蛋白及血小板在治疗3个月后开始稳定并回升。用药后最常见的不良反应为急性过敏反应及血清病反应（53%）,其次为感染（40%）。结论：对于不能行造血干细胞移植的SAA患者,ATG联合CsA是标准治疗方案,疗效满意。

Objective To investigate both the short-term effect and side effects of anti-thymocyte globulin（ATG） combined with cyclosporin A（CsA） therapy in patients with severe aplastic anemia（SAA） and provide basis for the treatment of SAA.Methods From December 2009 to May 2011,15 SAA patients treated by ATG combined with CsA therapy in our hospital were selected,the clinical effectiveness,the improvement of their symptoms after treatment,the changes of peripheral blood cell counts and the incidence of different side effects in treatment period were observed.Results Among 15 patients,there were 10 patients reached the treatment assessment time point： 4 patients got complete response（40.0%）,4 got partial response（40.0%）,while 1 patient had no response（10.0%）,1 patient died after ATG treatment（10.0%）,the overall effective rate was 80.0%.The patients who responsed to this therapy got their blood cells recovery 1-2 months after treatment： the white blood cell counts and neutrophil counts recovered first,while the hemoglobin and platelet recovered at least 3 months after ATG treatment.During the ATG treatment,the most common side effect was varying degrees of acute allergic reaction and serum disease（53%）,followed by infection（40%）.Conclusion For the SAA patients who are not suitable for homatopoietic stem cell transplantation,ATG combined with CsA is a standard therapy,with a satisfactory curative effect.