| 摘要: |
| ［摘要］ 目的 探讨强化免疫抑制联合脐血输注治疗重型再生障碍性贫血的近远期疗效及并发症。方法 选取该院1998-06～2015-09诊断为重型再生障碍性贫血患者54例，按有无加用CTX及输注脐血分为治疗组和对照组。治疗组30例患者均采用兔抗人胸腺免疫球蛋白（ATG）+环孢素A（CsA）+环磷酰胺（CTX）+脐血输注的方案：ATG 3.5 mg/（kg·d） D1～D5，CsA 3～5 mg/（kg·d）。CTX总量75 mg/kg，D2～D3，脐血在ATG使用后第3～5天（其中1 d）输注。对照组24例患者采用ATG+CsA的方案,ATG 3.5 mg/（kg·d） D1～D5，CsA 3～5 mg/（kg·d）。结果 治疗组中性粒细胞绝对值>0.5×109/L的中位时间为16（7～28）d，血小板计数>20×109/L的中位时间为46（12～132）d，感染发生率60%，感染病死率13%。经过中位28（1.2～176）个月的随访，总生存率为77.0%，无病存活率为66.7%。对照组中性粒细胞绝对值>0.5×109/L的中位时间为21（3～42）d，血小板计数>20×109/L的中位时间为56（12～102）d，感染发生率67%，感染病死率17%。经过中位20（0.9～118）个月的随访，总生存率为70.8%，无病存活率为62.5%。治疗组与对照组中性粒细胞恢复时间差异有统计学意义（P<0.05），血小板恢复时间差异无统计学意义（P>0.05）。两组临床疗效、感染发生率、病死率、总有效率及生存率差异无统计学意义（P>0.05）。结论 强化免疫抑制治疗联合脐血输注，与标准ATG+CsA方案相比，骨髓空虚期短，中性粒细胞恢复时间缩短，治疗相关副作用、感染发生率及病死率未增加。 |
| 关键词: 重型再生障碍性贫血 强化免疫抑制治疗 脐血输注 |
| DOI：10.3969/j.issn.1674-3806.2016.12.15 |
| 分类号:R 552 |
| 基金项目: |
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| A clinical analysis of intensive immunosuppressive therapy with umbilical cord blood cell infusion for severe aplastic anemia |
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LI Yu-miao, WANG Shun-qing, ZHANG Yu-ping, et al
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Department of Hematology, the First People′s Hospital of Guangzhou, Guangdong 510180, China
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| Abstract: |
| ［Abstract］ Objective To investigate the short and long term effects and complications of intensive immunosuppressive therapy in combination with cord blood infusion treatment of severe aplastic anemia(SAA).Methods Fifty-four patients with SAA in our hospital from June 1998 from September 2015 were divided into the treatment group and the control group, according to whether the use of CTX and the infusion of umbilical cord blood. Thirty cases of the treatment group were treated with ATG+CsA+CTX+cord blood infusion solutions: ATG 3.5 mg/（kg·d） D1～D5, CsA 3～5 mg/（kg·d）, CTX total 75 mg/kg, D2～D3, infusion of umbilical cord blood for one day 3～5 days after using ATG. 24 cases of the control group were treated with ATG+CsA: ATG 3.5 mg/（kg·d） D1～D5, CsA 3～5 mg/（kg·d）.Results For the treatment group: the median time of neutrophil count>0.5×109/L was 16(7～28)days, and the median time of platelet count>20×109/L was 46(12～132)days; The infection rate was 60%, and the infection mortality rate was 13%. The overall survival rate was 77.0%, after a median follow-up of 28 months(1.2～176), and the disease-free survival rate was 66.7%. For the control group: the median time of neutrophil count>0.5×109/L was 21(3～42)days, and the median time of platelet count>20×109/L was 56(12～102)days, the infection rate was 67%, and infection mortality rate was 17%. After a median follow-up of 20(0.9～118)months, the overall survival rate was 70.8%, the disease-free survival rate was 62.5%. There was significantly different in neutrophil recovery time but not different in platelet recovery time between the two groups. There were no significant differences in the clinical effect, the incidences of infection, mortality, total efficiency and survival rates between the two groups.Conclusion Compared with the standard ATG+CsA program, intensive immunosuppressive therapy combined with umbilical cord blood infusion has shorter bone marrow emptiness, and shorter neutrophil recovery time. It is clinically feasible, and dose not increase the treatment-related side effects and the incidence of infection and mortality. |
| Key words: Severe aplastic anemia(SAA) Intensive immunosuppressive therapy Umbilical cord blood infusion |
