以补肾中药为主联合抗淋巴细胞球蛋白/抗胸腺细胞球蛋白治疗重型再生障碍性贫血的预测因素

Prognostic Factor Analysis of Platelet Count on Nourishing the Kidney Herbs as the Main Regimen Together with ATG/ALG in the Treatment of Severe Aplastic Anemia

目的:探讨以补肾中药为主联合强烈免疫抑制剂抗淋巴细胞球蛋白/抗胸腺细胞球蛋白(ALG/ATG)的治疗预测因素。方法:选取1992年1月至2016年5月西苑医院血液科病房住院的重型再生障碍性贫血-I型患者151例,以补肾中药治疗为主,联合强烈免疫抑制剂ALG/ATG,并后期辅以环孢霉素A、雄性激素和造血生长因子等治疗重型再生障碍性贫血,观察临床疗效、预计生存率等指标。所有可以评价的140例重型再生障碍性贫血患者均随访1年以上。生存期自用药第1天开始计算,观察结束时间为2016年4月,观察1～276个月,中位观察时间54个月。结果:基本治愈30例(42.3%),缓解11例(15.5%),明显进步18例(25.4%),无效12例(16.9%),总有效率为83.1%。观察结束时整体生存率为83.6%。5年、10年的预计生存率分别为82.8%、80.3%。与疗效相关的15个因素,另外加上系数(常数),构成了预测疗效的4个方程,交叉验证试验显示该方程的疗效预测准确率为83.8%。结论:以补肾中药联合ATG/ALG为主治疗重型再生障碍性贫血可进一步提高有效率,疗效预测方程操作简单,在治疗早期可以进行疗效预测且疗效判别准确率高。

Objective： To analyze the effectiveness and prognostic factors（ platelet） of antithymus globulin（ ATG）/antilymphocyte globulin（ ALG） together with herbs of nourishing the kidney in treatment of severe aplastic anemia（ SAA）. Methods： A total of 151 cases with severe aplastic anemia who received ATG/ALG treatment in our hospital from January 1992 to May 2016 were analyzed retrospectively. They were treated mainly with nourishing herbs and combined with intense immunosuppression-ALG/ATG.And later cyclosporine A,male sex hormone and hemopoietic growth factor were used to treat severe aplastic anemia. Clinical efficacy,estimated survival rate were observed. Results： After one year follow up visit of 140 patients,the results showed 30 patients were basically cured（ 42. 3%）,11 relieved（ 15. 5%）,18 significantly improved（ 25. 4%） and 12 invalid（ 16. 9%）. The overall effect ratio was 83. 1%. The end time of observation was April 2016. The median observation period was 54 months（ 1-276 months）,and the overall survival rate was 83. 6% at the end of the observation. The expected survival rates of 5 years and 10 years were 82. 8% and 80. 3% respectively. Finally,15 factors related to the efficacy were screened out. In addition,the coefficients（ constants） were used to form the 4 equations for predicting the efficacy. The cross validation test showed that the accuracy of the equation was 83. 8%. Conclusion： Nourishing the kidney Chinese herbs together with ATG/ALG in the treatment of SAA was valid and safe,which could also improve clinical curative effect and longer patients＇ survival rate. The curative effect prediction equation is simple in operation,easy to popularize in clinic,which can predict the curative effect in the early stage of treatment,and has high accuracy. It is a promising system to predict the effect and evaluate the prognosis.