大剂量丙种球蛋白与环孢素A治疗儿童再生障碍性贫血的疗效分析

Therapeutic effects of a combination of high-dose immunoglobulin and cyclosporine A in children with aplastic anemia

摘要:

目的：阶段性总结大剂量丙种球蛋白（HDIG）联合环孢素A(CsA)、小剂量泼尼松（P）、雄激素等治疗儿童再生障碍性贫血（AA）的疗效，同时探讨初诊时血常规、外周血淋巴细胞亚群百分比、骨髓CD34+细胞等各项实验室指标与疗效的相关性。方法：对该院46例应用大剂量丙种球蛋白与环孢素A治疗的AA 患儿进行临床回顾分析及追踪随访。结果：HDIG＋CsA治疗46例AA患儿，总有效率67.4%（31/46）。经二分类logistic回归分析，中性粒细胞计数降低(B=4.703, P<0.05)是AA治疗效果不良的危险因素。外周血淋巴细胞亚群CD4+、CD8+分布百分比值以及CD4+/CD8+比值与HDIG＋CsA方案的疗效显著相关，CD4+、CD4+/CD8+比值正常患者治疗有效率显著高于比值降低患者（P<0.01）。而CD8+比值正常患者治疗有效率显著高于CD8+比值增高患者（P<0.05）。AA患儿CD34+细胞/有核细胞比值均低于正常水平，但其比值对疗效无显著影响（P>0.05）。结论：中性粒细胞计数、外周血淋巴细胞CD4+百分比及CD4+/CD8+比值是影响AA治疗效果的重要因素。HDIG+CsA+P联合治疗儿童AA有效率较高，安全经济，是目前治疗儿童AA的理想方案，值得临床推广。［中国当代儿科杂志，2009，11（1）：33-36］

Abstract:

OBJECTIVE: To evaluate the therapeutic effects of a combined immunotherapy, high-dose immunoglobulin (HDIG) plus cyclosporine A (CsA) plus prednisone (P), in children with aplastic anemia (AA) and to explore the association of peripheral blood lymphocyte subsets, peripheral blood cells and marrow CD34+ cells with therapeutic effects in AA. METHODS: The clinical data of 46 children with AA and who received the combined immunotherapy of HDIG + CsA + P were retrospectively studied. RESULTS: Of the 46 children with AA, 31 (67.4%) were responded to the combined immunotherapy. The binary logistic regression analysis showed low absolute neutrophil count (B=4.703, P<0.05), low percentage of peripheral blood CD4+ cells (B=0.142, P<0.05) and low ratio of peripheral blood CD4+/CD8+ （B=2.945, P<0.05）were associated with poor therapeutic effects. The ratio of CD34+/karyocytes of bone marrow in children with AA was lower than that in normal individuals, but it was not significantly related to the therapeutic effect. CONCXLUSIONS: The combined immunotherapy (HDIG+ CsA+P) was effective in children with AA. The absolute neutrophil count, the percentage of peripheral blood CD4+ and the ratio of peripheral blood CD4+/CD8+ were important prognostic factors in AA.［Chin J Contemp Pediatr, 2009, 11 (1):33-36］