CAJ | 학술논문

目的探寻降低重型再生障碍性贫血(SAA)患者早期死亡率并提高疗效的方法。方法采用前瞻性同期对照研究法，比较仅用抗淋巴细胞球蛋白/抗胸腺细胞球蛋白(ALG/ATG)和环孢菌素A(CsA)序贯强化免疫抑制治疗(SlIST)(36例)与SIIST联合造血生长因子(HGF)(37例)，即并用粒巨噬细胞集落刺激因子(GM-CSF)、红细胞生成素(Epo)或粒细胞集落刺激因子(G-CSF)、Epo治疗SAA的疗效。结果 SIIST联合HCF治疗组和单用HIIST组比较不仅早期感染率(分别为24.3％和55.3％)、死亡率(分别为4.0％和16.7％)有所降低，有效率(分别为89.2％和63.9％)有所提高，而且血常规、骨髓象恢复速度加快，成分输血脱离时间及骨髓造血祖细胞体外培养均优于SIIST组。两种不同HGF方案治疗组之间未见明显区别，均耐受良好。结论在ALG/ATG和CsA强化免疫抑制的基础上联合HGF治疗SAA，可降低早期死亡率、感染率，并获得较高的疗效。
목적탐심강저중형재생장애성빈혈(SAA)환자조기사망솔병제고료효적방법。방법채용전첨성동기대조연구법，비교부용항림파세포구단백/항흉선세포구단백(ALG/ATG)화배포균소A(CsA)서관강화면역억제치료(SlIST)(36례)여SIIST연합조혈생장인자(HGF)(37례)，즉병용립거서세포집락자격인자(GM-CSF)、홍세포생성소(Epo)혹립세포집락자격인자(G-CSF)、Epo치료SAA적료효。결과 SIIST연합HCF치료조화단용HIIST조비교불부조기감염솔(분별위24.3％화55.3％)、사망솔(분별위4.0％화16.7％)유소강저，유효솔(분별위89.2％화63.9％)유소제고，이차혈상규、골수상회복속도가쾌，성분수혈탈리시간급골수조혈조세포체외배양균우우SIIST조。량충불동HGF방안치료조지간미견명현구별，균내수량호。결론재ALG/ATG화CsA강화면역억제적기출상연합HGF치료SAA，가강저조기사망솔、감염솔，병획득교고적료효。
Objective To explore more effective regimen for reducing early mortality of severe aplastic ane mia (SAA) and improving therapeutic effectiveness. Methods Antilymphocyte globulin/antithymocyte globulin (ALG/ATG) and cyclosporine A(CsA) ( sequential intensified immunosuppressive therapy, SIIST), with or without hematopoietic growth factors (HGFs) were administered to 73 SAA patients in a prospective randomized clinical trial to test the effectiveness of the addition of HGFs for the patients. Results The response rate of SIIST with HGFs group was significantly higher than that of SIIST alone group(89.2% vs 63.9% ) ,with lower rates of early infection (24.3% vs 55.3% )and mortality(4.0% vs 16.7% ),shorter duration of cytopenia and blood transfusion dependence and faster recovery of bone marrow hematopoiesis. The addition of HGFs to SIIST was tolerated well in all patients. There was no difference in the treatment outcome of the two groups with GM-CSF plus Epo or G-CSF plus Epo. Conclusion The use of HGFs in combination with SIIST could reduce early infection and mortality rates and, therefore, improve the response rates in SAA patients.