猪抗人淋巴细胞免疫球蛋白联合环孢菌素A治疗重型再障的临床疗效

目的探讨使用国产猪抗人淋巴细胞免疫球蛋白（p-ALG）联合环孢菌素A（CsA）治疗重型再生障碍性贫血（SAA）的疗效及观察不良反应。方法应用p-ALG（30mg/kg/d,静脉滴注）联合CsA（起始量为5mg/kg/d）治疗SAA 8例,辅以促造血、成分血输注、造血生长因子等支持治疗。检测治疗前后外周血象及骨髓象变化,以流式细胞仪测定治疗前后外周血T淋巴细胞亚群的改变情况,观察不良反应及其处理效果。结果随访8例中,基本治愈2例,缓解3例,明显进步1例,早期死亡2例,总有效率75%。治疗显效时患者的外周血CD3＋CD4＋（Th）细胞比例升高,CD3＋CD8＋（Ts）细胞比例降低,Th/Ts比值升高,与治疗前比较,差异有统计学意义（P〈0.01）。结论使用国产p-ALG联合CsA作为初诊SAA的首次治疗方案效果良好,治疗费用较马或兔抗胸腺细胞免疫球蛋白（ATG）联合CsA方案更经济。

Clinical Efficacy of Pig Anti-Human Lymphocyte Immune Globulin Concomitant with Cyclosporine A on Severe Aplastic Anemia

Objective To explore the clinical efficacy of pig anti-human lymphocyte immune globulin（p-ALG）concomitant with cyclosporine A（CsA）on severe aplastic anemia（SAA）and to observe their adverse responses.Methods Intravenous injections of 30 mg/kg/d p-ALG concomitant with 5 mg/kg/d CsA were used on 8SAA patients.Support therapies such as injection of blood components and hematopoietic growth factor were supplemented.Peripheral hemogram and knochenbild myelogramm changes before and after treatment were detected,while T lymphocyte subgroups in peripheral blood before and after treatment were determined by flow cytometry.Adverse responses and the processing effect were observed.Results Of the 8patients finished follow-ups,2were completely cured,3were remised,1was improved and 2died early,with the total response rate being 75%.In patients with excellent efficacy,the CD3＋CD4＋（Th）cell ratio and Th/Ts ratio increased while CD3＋ CD8＋（Ts）cell ratio decreased,which had significant differences from treatment before（P〈0.05）.Conclusion p-ALG concomitant with CsA have favorable efficacy in the initial treatment of SAA,and cost less than horse or rabbit anti-thymocytes immune globulin concomitant with CsA.