32例再生障碍性贫血患者的临床分析

Clinical analysis of 32 patients with aplastic anemia

目的:分析32例再生障碍性贫血患者的临床特点、治疗过程及临床疗效,找出发病、疗效及预后相关因素。方法:采用病例回顾性分析的方法,查阅电子病例,检索所有2016年10月~2019年10月期间再生障碍性贫血的住院患者,收集住院患者的临床相关指标,归纳、整理及总结分析。结果:32例AA患者外周血检查提示一系减低1例,二系减低6例,三系减低25例,骨髓检查提示增生减低为20例,极度减低为12例,骨髓活检均表现为骨髓增生减低或重度减低。32例AA患者中,CAA患者16例,其中应用环孢素+雄激素组有效率为66.67%,单用雄激素组有效率为0,环孢素+雄激素+中药组有效率为71.43%。SAA患者16例,其中环孢素+雄激素组有效率为33.33%,环孢素+雄激素+激素组有效率为60.00%,单用激素组有效率为0,环孢素+雄激素+丙种球蛋白组有效率为50.00%。结论:再生障碍性贫血患者的临床特征以全血细胞减少、骨髓增生减低、造血细胞缺乏等为主,治疗以环孢素A、雄激素、糖皮质激素联合用药或加用中药为佳。

Objective Treatment process and clinical efficacy of 32 patients with aplastic anemia were analyzed to find out the related factors of pathogenesis,efficacy and prognosis.Method Retrospective case analysis was conducted to search electronic cases and retrieve all inpatients with aplastic anemia from October 2016 to October 2019.Relevant clinical indicators of inpatients were collected,summarized,sorted out and analyzed.Results In 32 patients with AA,peripheral blood examination showed 1 case of primary myelodysplasia,6 cases of secondary myelodysplasia,25 cases of tertiary myelodysplasia,bone marrow examination showed 20 cases of dysplasia,12 cases of extreme myelodysplasia,bone marrow biopsy showed myelodysplasia or severe myelodysplasia.Among 32 AA patients,16 cases were CAA patients.The effective rate was 66.67%in cyclosporine+androgen group,0%in androgen group and 71.43%in cyclosporine+androgen+traditional Chinese medicine group.The effective rate of CSA+androgen group was 33.33%,that of CSA+androgen+hormone group was 60%,that of steroid group was 0%,and that of CSA+androgen+gamma globulin group was 50%.Conclusion The main clinical features of aplastic anemia patients are pancytopenia,myelodysplasia and hemopoietic cell deficiency.The combination of cyclosporine A,androgen and glucocorticoid or traditional Chinese medicine is the best treatment.