环孢素A治疗慢性再生障碍性贫血疗效观察

Effect of cyclosporine A on chronic aplastic anemia

目的探讨环孢素A治疗慢性再生障碍性贫血（CAA）的临床效果。方法 100例CAA患者分为观察组和对照组,每组50例。对照组患者给予甲睾酮片、促红细胞生成素等常规治疗,治疗3个月;观察组患者在常规治疗的基础上给予环孢素A 8 mg·kg-1·d-1,口服,每日2次,保持血药浓度为200~400 ng·L-1,治疗3个月。治疗结束后,对比2组患者的治疗效果。结果观察组和对照组患者治疗有效率分别为90.0%（45/50）和70.0%（35/50）,观察组患者治疗有效率显著高于对照组（χ2=71.42,P〈0.05）。观察组5~24岁、25~54岁和≥55岁患者治疗有效率分别为63.2%（12/19）、68.8%（11/16）和46.7%（7/15）,5~24岁和25~54岁患者治疗有效率显著高于≥55岁患者（χ2=25.312,P〈0.05）,但5~24岁与25~54岁患者治疗有效率比较差异无统计学意义（χ2=15.305,P〉0.05）。观察组不同病程患者治疗有效率比较差异无统计学意义（χ2=6.150,P〉0.05）。观察组治疗前不同血红蛋白水平患者治疗有效率比较差异无统计学意义（χ2=11.052,P〉0.05）。观察组中性粒细胞绝对值（ANC）≥0.5×109L-1和ANC〈0.5×109L-1患者治疗有效率分别为69.7%（23/33）和41.2%（7/17）,ANC≥0.5×109L-1患者的治疗有效率显著高于ANC〈0.5×109L-1患者（χ2=35.738,P〈0.05）。观察组血小板（PLT）≥20×109L-1和PLT〈20×109L-1患者治疗有效率分别为69.2%（18/26）和45.8%（11/24）,PLT≥20×109L-1患者的治疗有效率显著高于PLT〈20×109L-1患者（χ2=46.251,P〈0.05）。观察组治疗前骨髓粒细胞系与红细胞系比值（G∶E）≤2.0∶1和G∶E〉2.0∶1患者的治疗有效率分别为82.7%（24/29）和28.6%（6/21）,骨髓G∶E≤2.0∶1患者的治疗有效率显著高于G∶E〉2.0∶1患者（χ2=8.237,P〈0.05）。结论环孢素A治疗CAA具有良好的疗效,且其疗效与患者年龄、ANC、PLT、G∶E比值等因素有关。

Objective To investigate the effect of cyclosporine A on chronic aplastic anemia（ CAA）. Methods One hundred patients with CAA were divided into observation group and control group,fifty patients in each group. The patients in control group were treated with conventional therapy for three months,such as testosterone tablets and erythropoietin. Based on the conventional therapy,the patients in observation group were treated with cyclosporine A 8 mg·kg- 1·d- 1by oral,twice a day for three months,the blood drug level was 200- 400 ng·L- 1. The effect was compared between the two groups after treatment. Results The effective rate in observation group and control group was 90. 0%（ 45 /50） and 70. 0%（ 35 /50）,the effective rate in observation group was significantly higher than that in control group（ χ2= 71. 42,P 〈 0. 05）. In observation group,the effective rate of 5- 24,25- 54 and ≥55 years old patients was 63. 2%（ 12 /19）,68. 8%（ 11 /16） and 46. 7%（ 7 /15） respectively. The effective rate of 5- 24 and 25- 54 years old patients was significantly higher than that of ≥55 years old patients（ χ2= 25. 312,P 〈 0. 05）,but there was no significant difference in the effective rate between 5- 24 and 25- 54 years old patients（ χ2= 15. 305,P 〉 0. 05）. In observation group,there was no significant difference in the effective rate between the patient with different course of disease（ χ2= 6. 150,P 〉 0. 05）,there was no significant difference in the effective rate between the patient with different hemoglobin level before treatment（ χ2= 11. 052,P 〉 0. 05）. In observation group,the effective rate of patients with absolute neutrophil count（ ANC） ≥0. 5 × 109L- 1and ANC 〈 0. 5 × 109L- 1was 69. 7%（ 23 /33） and 41. 2%（ 7 /17） respectively,the effective rate of patients with ANC ≥0. 5 × 109L- 1was significantly higher than that of patients with ANC 〈 0. 5 × 109L- 1（ χ2= 35. 738,P 〈 0. 05）. In observation group,the effective rate of patients with platelet（ PLT） ≥20 ×109L- 1and 〈 20 × 109L- 1was 69. 2%（ 18 /26） and 45. 8%（ 11 /24） respectively,the effective rate of patients with PLT≥20 × 109L- 1was significantly higher than that of patients with PLT 〈 20 × 109L- 1（ χ2= 46. 251,P 〈 0. 05）. In observation group,the effective rate of patients with bone marrow granulocyte and erythrocyte system ratio（ G∶E） ≤2. 0∶1 and 〉 2. 0∶1 was 82. 7%（ 24 /29） and 28. 6%（ 6 /21） respectively,the effective rate of patients with G∶E≤2. 0 ∶1 was significantly higher than that of patients with G∶E 〉 2. 0 ∶1（ χ2= 8. 237,P 〈 0. 05）. Conclusion Cyclosporine A for treating CAA has good effect,and the effect is related to age,ANC,PLT and G∶E ratio.