免疫抑制治疗成人重型再生障碍性贫血的近期疗效及长期生存情况随访研究

Short and Long Term Efficacy of Immunosuppressive Therapy and Survival in Adult Severe Aplastic Anemia

目的:评价免疫抑制治疗(immunosuppressive therapy,IST)成人重型再生障碍性贫血患者的近期疗效及长期生存情况,探讨临床因素(年龄、分型、治疗前淋巴细胞百分比、网织红细胞百分比及中性粒细胞计数)与疗效的关系。方法:分析2009年09月至2013年09月接受IST的39例SAA患者1个月、3个月、6个月、1年的有效率及所有患者达到有效的时间,长期随访并计算1年的生存率。用χ2检验比较接受IST治疗者与未接受者的1年总生存率、输注红细胞悬液量及血小板悬液量。用多项logistic回归分析法分析5个临床因素与疗效的关系。结果:39例SAA患者1个月的有效率为29.73%,3个月的有效率为70.27%,6个月的有效率为75.68%,1年的有效率为86.49%;所有患者达到有效的中位时间为61.5 d(10-344 d);接受IST治疗的患者1年生存率为92.31%,与未接受组相比统计学差异明显(P<0.05);治疗组第1年平均月红细胞输注量为1.04(0.13-2.78)×400 ml/月,血小板1.38(0.17-5.10)×200 ml/月,与未接受组比较统计学差异明显(P<0.01);5个临床因素中,年龄、治疗前淋巴细胞百分比及中性粒细胞计数与IST疗效有关(P<0.05)。结论:接受IST治疗患者的1年有效率为86.49%,其长期生存情况优于未接受者,年龄、治疗前淋巴细胞百分比及中性粒细胞计数与IST疗效有关。

Objeetlve： To evaluate the short and long term therapeutic efficacy of the immunosuppressive therapy （IST） for adult severe aplastic anemia（ SAA）, and to analysis the relationship between the clinical factors（ age,typing, lymphocyte percentage, reticulocyte percentage, neutrophil count） and the response to IST. Methods： The response rate of 39 patients received the IST between September 2009 and September 2013 in our hospital was assayed, the effective time in which all patients had hematologic response, and the survival rate at the first year were analyzed. The survival rates, the average amounts of the RBC and Pit transfusion per month in the first year were compared by using x2 test between the IST group and the non-IST group; the multinomial logistic regression was used to analyze the relationship be- tween the clinical factors and the response to IST. Results： The response rates of the 39 SAA patients at the first month, the third month, the sixth month and the first year were 29.73%, 70.27%, 75.68%, 86.49%, respectively. The median effective time of hematologic response in all patients had was 61.5 d（ 10 d - 344 d）. The survival rate of the IST group was 92.31%, which was much higher than that of the non-IST group （ P 〈 0.05 ）. The average amounts of the RBC and Plt transfusion per month at the first year in the IST group were 1.04（0.13 -2.78） x400 ml and 1.38（0.17 -5.10） x200 ml, respectively, which were much lower than those in the non-IST group（P 〈0.01 ）. Among the five clinical factors, the age, lymphocyte percentage and neutrophil count related to the response of IST（ P 〈 0.05 ）. Conclusion： The response rate of the 39 SAA patients received IST is 86.49% at the first year, and their long term survival is better than that of non-IST group. The age, lymphocyte percentage and neutrophil count relate to the response of IST.