三氧化二砷联合环孢素治疗再生障碍性贫血的机制研究

Mechanism of arsenic trioxide combined with cyclosporine in the treatment of aplastic anemia

目的研究三氧化二砷联合环孢素治疗再生障碍性贫血的效果,并进一步分析可能存在的作用机制。方法将136例确诊为再生障碍性贫血的患者根据用药不同分成A组(三氧化二砷组)、B组(环孢素组)和C组(三氧化二砷联合环孢素组)。A、B和C组分别为48,43和45例。观察3组患者的临床疗效并对比分析3组患者血红蛋白(Hb)、白细胞(WBC)、血小板(PLT)含量、干扰素-γ(IFN-γ)、T细胞辅助细胞1/2(Th1/Th2)的水平。结果3组的基本痊愈率、显效率、有效率和无效率:A组分别为35.42%,25.00%,27.08%和12.50%,B组为44.19%,23.26%,20.93%和11.63%,C组为62.22%,33.33%,2.22%和2.22%。C组基本痊愈率(χ^2=6.907,P=0.032)和有效率(χ^2=10.939,P=0.004)显著高于A组和B组。3组患者治疗后Hb、WBC及PLT含量均明显高于治疗前(P<0.05)。C组Hb、WBC及PLT含量增加的幅度显著高于A组和B组(P<0.05);A组和B组间未见明显差异。治疗后3组患者IFN-γ和Th1/Th2水平均明显低于治疗前(P<0.05)。C组IFN-γ和Th1/Th2水平降低的幅度显著高于A组和B组(P<0.05);A组和B组间未见明显差异。结论三氧化二砷联合环孢素治疗再生障碍性贫血的效果确切,能够有效升高相关血液指标,且明显优于单药治疗效果,其机制可能与三氧化二砷和环孢素共同调节IFN-γ和Th1/Th2水平有关,进而提升对病情的控制效果。

Objective To explore the effects of arsenic trioxide combined with cyclosporine in the treatment of aplastic anemia and further analyze the possible mechanisms of action.Methods 136 patients diagnosed with aplastic anemia were admitted to our hospital.They were divided into group A(arsenic trioxide group),group B(cyclosporine group)according to the medication,and group C(arsenic trioxide combined with cyclosporine group).There were 48 cases in group A,43 cases in group B,and 45 cases in group C.The clinical efficacy of the 3 groups of patients was observed and the levels of hemoglobin,white blood cells,platelets and IFN-γ,Th1/Th2 in the 3 groups were compared.Results The basic cure rate,significant efficiency,efficiency and inefficiency were 35.42%,25.00%,27.08%and 12.50%for the group A,44.19%,23.26%,20.93%and 11.63%for the group B,62.22%,33.33%,2.22%and 2.22%for the group C.The group C was significantly higher than the group A and group B in the basic cure rate(χ^2=6.907,P=0.032)and the effective rate(χ^2=10.939,P=0.004).The levels of hemoglobin,white blood cells and platelets in the 3 groups were significantly higher than those before treatment(P<0.05).The increase of hemoglobin,white blood cell and platelet content in group C was significantly higher than that in group A and group B(P<0.05).There was no significant difference between group A and group B.After treatment,the levels of IFN-γand Th1/Th2 in the 3 groups were significantly lower than those before treatment(P<0.05).The reduction of IFN-γand Th1/Th2 levels in group C was significantly higher than that in group A and group B(P<0.05).There was no significant difference between the 2 groups.Conclusion The effect of arsenic trioxide combined with cyclosporine in the treatment of aplastic anemia is effective,which can effectively increase the relevant blood indicators,and is significantly better than their respective treatment effects.The mechanism may be related with the combination regulating IFN-γ,Th1/Th2 levels,thereby improving the control effect on the condition.