补肾中药结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免疫作用及预测机制研究

Study on the immune effect and predictive mechanism of kidney-tonifying Chinese herbs combined with anti-lymphocyte globulin/anti-thymocyte globulin in the treatment of severe aplastic anemia

目的:探讨补肾中药结合抗淋巴细胞球蛋白(ALG)/抗胸腺细胞球蛋白(ATG)治疗重型再生障碍性贫血(SAA)的免疫作用及预测机制。方法:选取2018年1月—2023年6月在甘肃省中医院被诊断为SAA的140例患者,依据随机1∶1分配原则,分为常规治疗组和联合补肾中药治疗组,每组70例。常规治疗组给予ALG/ATG进行免疫治疗,联合补肾中药治疗组在常规治疗组常规免疫治疗的基础上联合补肾中药进行治疗。观察并比较两组患者的临床总有效率、免疫指标(血红蛋白、网织红细胞、血小板以及中性粒细胞)水平、生存率预测效果以及不良反应的发生情况。结果:联合补肾中药治疗组患者的治疗总有效率高于常规治疗组的治疗总有效率,差异有统计学意义(P<0.05)。联合补肾中药治疗组免疫指标血红蛋白、网织红细胞、血小板以及中性粒细胞的水平均高于常规治疗组,差异有统计学意义(P<0.05)。观察结束时,两组患者的整体生存率为83.58%。联合补肾中药治疗组5年、10年的预计生存率(83.11%、80.27%)高于常规治疗组5年、10年的预计生存率(77.82%、75.37%),差异有统计学意义(P<0.05)。治疗后,联合补肾中药治疗组的不良反应发生率与常规治疗组比较,差异无统计学意义(P>0.05)。结论:采取抗淋巴细胞球蛋白/抗胸腺细胞球蛋白结合补肾中药联合治疗SAA,治疗总有效率更高,且治疗早期疗效的预测准确率高,同时还具备提高免疫能力的效果,可以在临床进行一定范围的推广与应用。

Objective:To investigate the immune effect and predictive mechanism of kidney-tonifying Chinese herbs combined with anti-lymphocyte globulin(ALG)/anti-thymocyte globulin(ATG)in the treatment of severe aplastic anemia(SAA).Methods:A total of 140 patients diagnosed with SAA in Gansu Provincial Hospital of Traditional Chinese Medicine from January 2018 to June 2023 were selected and divided into conventional treatment group and combined treatment group with kidney-tonifying Chinese herbs according to the random 1:1 allocation principle,with 70 cases in each group.The patients in the conventional treatment group were given ALG/ATG immunotherapy,and the patients in the combined treatment group with kidney-tonifying Chinese herbs were treated with kidney-tonifying Chinese herbs on the basis of the conventional immunotherapy in the conventional treatment group.The clinical total effective rate,immune indicators(hemoglobin,reticulocyte,platelet and neutrophils)levels,survival rate prediction effect and adverse reactions were observed and compared between the two groups.Results:The total effective rate of the combined treatment group with kidney-tonifying Chinese herbs was higher than that of the conventional treatment group,and the difference was statistically significant(P<0.05).The levels of immune indicators of hemoglobin,reticulocyte,platelet and neutrophils in the combined treatment group with kidney-tonifying Chinese herbs were higher than those in the conventional treatment group,and the differences were statistically significant(P<0.05).At the end of observation,the overall survival rate of the two groups was 83.58%.The 5-year and 10-year predicted survival rates(83.11%and 80.27%)in the combined treatment group with kidney-tonifying Chinese herbs were higher than those in the conventional treatment group(77.82%and 75.37%),and the difference was statistically significant(P<0.05).After treatment,there was no significant difference in the incidence of adverse reactions between the combined treatment group with kidney-tonifying Chinese herbs and the conventional treatment group(P>0.05).Conclusion:ALG/ATG combined with kidney-tonifying Chinese herbs in the treatment of SAA has a higher total effective rate and the prediction accuracy of early therapeutic effect,and it also has the effect of improving immune ability,which can be promoted and applied in a certain range in clinical practice.