抗人T-细胞兔免疫球蛋白联合环孢菌素A治疗儿童再生障碍性贫血的临床疗效观察

Clinical efficacy of anti-human T-cell rabbit immunoglobulin( ATG-F) combined with cyclosporin A in the treatment of children with aplastic anemia

目的探讨抗人T-细胞兔免疫球蛋白(ATG-F)联合环孢菌素A(CSA)治疗儿童再生障碍性贫血的临床疗效及影响因素。方法选取儿童再生障碍性贫血者40例,其中重型再障(SAA)22例,极重型再障(VSAA)8例,依赖输血型非重型再障(NSAA)10例。采用ATG-F联合环孢菌素A的免疫抑制疗法。观察治疗前后T细胞亚群、疗效和影响因素。结果治疗后CD3+和CD4+的细胞比例显著升高,CD8+细胞比例显著下降,CD4+/CD8+比值显著升高,差异有统计学意义(P<0.05);随访1年后发现,患儿的总有效率为72.5%(SAA+VSAA组为70.0%、NSAA组为80.0%),总生存率为85.0%,且SAA+VSAA组和NSAA组的各项疗效比较差异无统计学意义(P>0.05);疾病严重程度、性别、年龄与疗效无相关性,病程和淋巴细胞绝对计数下降幅度与疗效有相关性(P<0.05)。病程≤6个月的患儿治疗有效率显著高于病程>6个月者(P<0.05),淋巴细胞绝对计数下降幅度>2×10~9·L^(-1)的患儿有效率显著高于≤2×10~9·L^(-1)者(P<0.05)。结论 ATG-F与CSA联合使用治疗儿童再生障碍性贫血可改善T细胞功能异常,提高疗效,且早期治疗效果更优,同时提示两组药物联合使用时需对药物剂量进行个体化研究,保证免疫抑制疗效。

Objective To investigate the clinical effect and influencing factors of ATG-F combined with cyclosporin A （ CSA） in the treatment of children with aplastic anemia. Methods 40 children with aplastic anemia that were treated in our hospital were selected, which including 22 with severe aplastic anemia（SAA） ,8 with very severe aplastic anemia（ VSAA） and 10 with blood transfusion de-pendent non-severe aplastic anemia（ NSAA）. The immunosuppressive therapy using ATG-F combined with CSA was taken. The changes of T cell subsets,the curative effect and the influencing factors before and after treatment were observed. Results After treatment, the proportion of CD4 ＋ and CD3 ＋ cells was significantly increased, the percentage of CD8 ＋ cells decreased significantly, and the ratio of CD4 ＋ / CD8 ＋ was significantly increased. The difference was statistically significant （P 〈 0 .0 5 ） . After 1 year follow-up, patients with the total effective rate was 72. 5% （70% in SAA ＋ VSAA group,NSAA group of 80% ） . The total survival rate was 85 % ,and the cur-ative effect of SAA ＋ VSAA group and NSAA group had no significant difference （ P 〉 0. 05 ） . There is no correlation between severity of disease,gender,age and curative effect,but the course of disease and the decrease of absolute lymphocyte count were correlated with the curative effect. The effective rate of treatment in patients of less than 6 months was significantly higher than that above 6 months （P 〈 0.05）. Absolute lymphocyte count decreased more than 2×109·L-1 patients had significantly higher efficiency than 2 ×109·L-1（P 〈 0. 05 ） . Conclusion Atg-F and CSA combined treatment of children with aplastic anemia can improve the abnormal T cell func-tion and the efficacy. The earlier the treatment started,the better the effect is,which also suggests that two groups of drugs are used in combination to for the drug dose of individual studies to ensure efficacy of immunosuppressive therapy.