再生障碍性贫血患者妊娠期应用环孢素A的研究进展

Research progress of eyclesporine therapy for peri-pregnancy aplastic anemia patients

再生障碍性贫血（AA）的发病机制极为复杂，免疫异常介导的造血功能抑制是其主要的病理生理机制。目前，虽然随着支持治疗的日臻完善，育龄期女性AA患者已可以成功妊娠，并且超过〉50％AA患者可获得良好妊娠结局，但是AA患者妊娠期的母婴并发症仍较常见。AA患者在妊娠期可以应用环孢素A进行治疗，但该药物治疗可能会增加其妊娠期并发症的发生风险。因此，妊娠期间应对使用环孢素A治疗的AA患者进行严密监测，一旦出现严重药物不良反应，则根据病情及时停用环孢素A或终止妊娠。产后6个月内，AA患者外周血细胞计数逐渐恢复正常，需根据其血药浓度及时调整环孢素A剂量。哺乳期应用环孢素A的AA患者可将该药分泌至乳汁，然而，母乳环孢素A含量常较低，并且新生儿摄取母乳后的环孢素A血药浓度也较低。但是，AA患者在使用环孢素A期间实施母乳喂养的安全性仍缺乏长期随访数据证实，因此该类患者需权衡利弊后，再进行母乳喂养的选择。

The pathogenesis of aplastic anemia（AA） is extremely complicated. The immune-mediated destruction of hematopoietic stem cells has been considered the main pathophysiological mechanism of AA. Successful pregnancy of AA patients are possible. More than 50% of them have good pregnancy outcomes. Nevertheless, maternal and infant＇s complications in AA patients with pregnancy are very common. It is safe to use cyclosporine A to treat AA in pregnancy. However, the risk of maternal and infant＇s complications would be increased. It is essential that the AA patients who is taking cyclosporine A should be monitored closely and frequently throughout pregnancy. Once severe drug side effects appear without control, discontinue cyclosporine A or terminate pregnancy. Cyclosporine A can be excreted into breast milk, while the ingestion amount of cyclosporine A through breast feeding and the levels of serum cyclosporine A are relatively low in most infants. While there is a lack of information about long-term outcomes, the safety of taking cyclosporine A while breast-fed is still controversial. As a result, when advising patients regarding breast-feeding, the advantages should be balanced with the minimal risk of exposure to cyclosporine A in breast milk.