环孢素血药浓度水平对重型再生障碍性贫血患者免疫抑制治疗近期疗效的影响
배포소혈약농도수평대중형재생장애성빈혈환자면역억제치료근기료효적영향
Effects of concentration of cyclosporine A on the early response to immunosuppressive therapy in severe aplastic anemia
  • 万方数据
    中华血液学杂志 중화혈액학잡지
    Chinese Journal of Hematology
    2011年 11期 766-771 ,共6页

    梁立艳%张莉%井丽萍%周康%王晓丹%李洋%彭广新%李园%李建平%史丽慧%叶蕾%樊慧慧%章萍%储榆林%张凤奎

    량립염%장리%정려평%주강%왕효단%리양%팽엄신%리완%리건평%사려혜%협뢰%번혜혜%장평%저유림%장봉규

    环孢素%药物监测%贫血,再生障碍性%治疗结果 環孢素%藥物鑑測%貧血,再生障礙性%治療結果
    배포소%약물감측%빈혈,재생장애성%치료결과
    Cyclosporine A%Blood concentration monitoring%Anemia,aplastic%Outcome
    目的 研究环孢素(CsA)血药浓度水平是否影响重型和(或)极重型再生障碍性贫血(SAA/VSAA)患者免疫抑制治疗(IST)早期疗效,探讨CsA的合理使用方法.方法 回顾性分析兔源抗胸腺细胞球蛋白(r-ATG)联合CsA方案初始治疗的90例SAA/VSAA患者临床资料,分别比较IST后6个月获得治疗反应和未获治疗反应患者间CsA血药浓度水平的差异,以及不同CsA血药浓度对SAA/VSAA患者获得治疗反应的影响.结果 ①初始CsA血药浓度对SAA/VSAA患者近期IST疗效无影响,但与SAA患者更早获得治疗反应相关；②获得治疗反应组患者IST第3个月CsA谷值血药浓度(C0)和峰值血药浓度(C2)均较未获治疗反应组患者明显增高(P值分别为0.024和0.009),IST其他时间段CsA血药浓度平均水平两组间差异无统计学意义(P＞0.05).③IST第3个月C0≥200 μg/L组患者治疗反应率为82.4％,明显高于C0 150～200μg/L组的55.6％ (P =0.023)和C0＜150 μg/L组的59.3％ (P =0.046)；IST第3个月C2≥700 μg/L组患者治疗反应率为80.5％,明显高于C2 ＜700 μg/L组的55.3％ (P =0.012).结论 CsA血药浓度水平影响SAA/VSAA患者近期疗效；IST第3个月CsA血药浓度水平对患者获得早期疗效尤为重要,维持CsA血药浓度C0≥200 μg/L、G2≥700 μg/L或可进一步提高SAA/VSAA患者IST治疗反应率.
    목적 연구배포소(CsA)혈약농도수평시부영향중형화(혹)겁중형재생장애성빈혈(SAA/VSAA)환자면역억제치료(IST)조기료효,탐토CsA적합리사용방법.방법 회고성분석토원항흉선세포구단백(r-ATG)연합CsA방안초시치료적90례SAA/VSAA환자림상자료,분별비교IST후6개월획득치료반응화미획치료반응환자간CsA혈약농도수평적차이,이급불동CsA혈약농도대SAA/VSAA환자획득치료반응적영향.결과 ①초시CsA혈약농도대SAA/VSAA환자근기IST료효무영향,단여SAA환자경조획득치료반응상관；②획득치료반응조환자IST제3개월CsA곡치혈약농도(C0)화봉치혈약농도(C2)균교미획치료반응조환자명현증고(P치분별위0.024화0.009),IST기타시간단CsA혈약농도평균수평량조간차이무통계학의의(P＞0.05).③IST제3개월C0≥200 μg/L조환자치료반응솔위82.4％,명현고우C0 150～200μg/L조적55.6％ (P =0.023)화C0＜150 μg/L조적59.3％ (P =0.046)；IST제3개월C2≥700 μg/L조환자치료반응솔위80.5％,명현고우C2 ＜700 μg/L조적55.3％ (P =0.012).결론 CsA혈약농도수평영향SAA/VSAA환자근기료효；IST제3개월CsA혈약농도수평대환자획득조기료효우위중요,유지CsA혈약농도C0≥200 μg/L、G2≥700 μg/L혹가진일보제고SAA/VSAA환자IST치료반응솔.
    Objective To evaluate the effects of cyclosporine A (CsA) whole-blood concentration on the early response to immunosuppressive therapy (IST) in severe and very severe aplastic anemia ( SAA/ VSAA).Methods Ninety SAA/VSAA patients treated with rabbit antithymocyte globulin (ATG) plus CsA as first line therapy in our hospital were retrospectively analysed.CsA levels between the response group and non-response group,and response rates of patients with variant CsA levels were compared respectively.Results ①There was no significant difference in the beginning unmodified CsA blood concentration between IST responded and non-responded SAA/VSAA patients.The beginning unmodified Co 133.91 ug/L in IST 2-month responders was higher than that of 49.9 ug/L in non-responded SAA patients ( P =0.009 ) ; ②The mean CsA Co and C2 levels during the third month following IST were significantly different in responders and non-responders ( 197.52 μg/L vs 161.49 μg/L,P =0.024,and 738.76 μg/L vs 615.46 μg/L,P =0.009 ),and no significant difference in other periods of IST(P＞0.05) ; ③The response rate (87.5％) was significantly higher in patients with CsA C0 ≥200μg/L the third month following IST than those of 55.6％ in patients with CsA Co 150 -200 μg/L(P =0.023) and 59.3％ in patients with CsA C0 ＜ 150 μg/L(P =0.046),respectively.The response rate was significantly higher of C2 ≥700 μg/L group than that of C2 ＜700 μg/L group( 80.5％ vs 55.3％,P =0.012).Conclusions The CsA concentration related to the early IST response.The third month CsA concentrations was the most important for the response and maintaining CsA levels with Co ≥200 μg/L and C2 ≥700 μg/L may improve the response to IST in SAA/VSAA.
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