三氧化二砷联合环孢霉素A治疗再生障碍性贫血的疗效分析

Evaluation and analysis of the treatment of aplastic anemia in the treatment of aplastic anemia by combined cyclosporine trioxide

目的:评价三氧化二砷(ATO)联合免疫抑制剂环孢霉素A(CsA)治疗再生障碍性贫血(AA)的临床疗效,从细胞分化角度分析原因。方法:54例AA患者分为试验组和对照组,每组27例。试验组接受ATO联合CsA治疗,对照组接受CsA治疗,患者同时常规口服司坦唑醇片,比较2组患者的临床疗效。获取治疗前患者骨髓,分离骨髓间充质干细胞(MSC),实验组加入0.001 mmol/L的ATO和2.5 mmol/L CsA,对照组加入2.5 mmol/L CsA,观察2组MSC成脂与成骨分化的情况。结果:试验组22例完全缓解,5例为部分缓解,有效率为100.0%。对照组5例完全缓解,6例为部分缓解,有效率为40.7%。2组治疗效果比较差异有统计学意义(P<0.05)。细胞形态学观察发现实验组骨髓MSC促进成骨细胞分化及抑制成脂细胞分化的作用强。结论:ATO联合CsA通过调控AA患者骨髓MSC成脂与成骨分化,可以较好地治疗AA。

Aim： To evaluate the clinical efficacy of arsenic trioxide（ ATO） combined with cyclosporine A（ CsA） in the treatment of aplastic anemia（ AA）,and analyze the causes from the perspective of cell differentiation. Methods： Fiftyfour patients with AA were randomly allocated into trial group and control group with 27 patients in each group. The trial group was treated with ATO combined with CsA,and the control group received single CsA treatment,all patients were given regular oral Stanozolol tablets,and then compared the clinical efficacy of the two groups. Bone marrow mesenchymal stem cells（ MSC） were isolated from patients before treatment. ATO（ 0. 001 mmol/L） and CsA（ 2. 5 mmol/L） were added to the experimental group,and CsA（ 2. 5 mmol/L） was added to control group. The adipogenic and osteogenic differentiation of bone marrow MSC in two groups were observed. Results： In the trial group,22 patients achieved complete remission,5 achieved partial remission,and the objective response rate was 100%; In control group,5 patients achieved complete remission,6 achieved partial remission,and the objective response rate was 40. 7%; the objective response between the two groups had statistical difference（ P 0. 05）. Cell morphology observation showed that the experimental group promoted bone marrow MSC osteoblast differentiation and inhibited the differentiation of adipocytes. Conclusion： ATO combined with CsA can better treat AA patients by regulating the imbalance of bone marrow MSC adipogenic and osteogenic differentiation in AA patients.