粒细胞集落刺激因子治疗成人再生障碍性贫血伴严重感染的临床研究

目的探讨粒细胞集落刺激因子（G—CSIz）治疗成人再生障碍性贫血（AA）伴严重感染的临床效果。方法2015年1月至2017年1月伴有感染的再生障碍性贫血患者86例，随机分为观察组和对照组各43例，对照组采取营养支持、抗感染等常规对症治疗，观察组患者在常规疗法基础上给予G—CSF治疗，比较两组患者治疗效果、感染相关病死率、外周血T细胞亚群变化情况。结果观察组临床总有效率为95．35％，明显高于对照组79．07％，差异有统计学意义（P〈0.05）；治疗后两组患者白细胞、血小板、血红蛋白、CD8＋等指标水平明显高于治疗前，CD3＋、CD4＋等指标水平明显低于治疗前，其中观察组患者各项指标改善水平均明显优于对照组，差异有统计学意义（P〈0．05）；观察纽患者感染相关病死率4．65％，克隆性演变发生率为11.63％，对照组分别为11.63％和2.33％，差异有统计学意义（P〈0.05）。结论G—CSF联合免疫抑制法治疗成人再生障碍性贫血伴严重感染患者，能够提高患者的免疫功能，改善症状和体征，降低感染相关病死率，具有较高的临床应用价值。

Objective To investigate the clinical efficacy of granulocyte colony stimulating factor （ G-CSF ） in the treatment of adult aplastic anemia with severe infection. Methods 86 cases aplastic anemia patients with infection in our hospital from January 2015 to January 2017 were selected as the research objects and randomly divided into study group and control group with 43 cases in each group, the patients in the study group were treated with G-CSF treatment on the basis of conventional therapy. The treatment effect, infection related mortality and peripheral blood T cell subsets changes in two groups of patients were observed and compared. Result The total effective rate of the clinical study group was 65.35%, 79.07% higher than the control group, the difference was statistically significant （P〈0.05） ; two groups of white blood cells and platelets, hemoglobin, CD8＋ index were significantly higher after treatment than that before treatment, CD3＋, CD4＋ and other indicatom were significantly lower than those before treatment. Which indicators to improve the level of patients in the study group were significantly better than the control group, the difference was statistically significant （P〈0.05） ; the study group patients with infection related mortality was 4.65%, clonal evolution rate was 9.30%, the control group were lower than those of the control group were 11.63% and 2.33%, no statistically significant difference （P〉0.05） . Conclusion G-CSF combined with immunosuppressive therapy for adults with severe aplastic anemia patients can improve the clinical effects of patients, reduce the infection incidence of death, promote immune function and improve symptoms and signs, the effect is significant, it has high chnical value.