抗胸腺球蛋白联合环孢素A治疗儿童重型再生障碍性贫血9例分析

目的探讨联合使用抗胸腺球蛋白（ATG）及环孢素A（CSA）治疗儿童重型再生障碍性贫血（SAA）的疗效及影响因素。方法应用ATG联合CSA治疗9例儿童SAA。ATG4—5mg／（kg·d）静脉滴注，CSA起始量为3-5mg!（kg·d），辅以成分血输注、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的变化，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。结果随访9例中基本治愈3例，缓解3例，明显进步2例，死亡1例，总有效率为88．89％。治疗后3个月外周血CD4＋细胞比例升高，CD8＋细胞比例降低，CD4＋／CD8＋比值升高，与治疗前比较差异有统计学意义（P〈0．01）。结论联合使用ATG、CSA作为初诊儿童SAA的首次治疗方案效果良好。

Evaluation of combined anti-thymocyte globulin and cyclosporin A therapy in the treatment of severe aplastic anemia in children

Objective To analyze the effectiveness of combined anti-thymocyte globulin （ATG） and cyclosporin A （CSA） therapy in the treatment of children with severe aplastic anemia （SAA）. Methods 9 children with SAA from the Department of Pediatrics, the first affiliated hospital of Shenzhen university, were studied retrospectively. All of them were treated with ATG 4-5 mg/（kg.d） and CSA 3~5 mg/（kg.d）, assisting with G-CSF treatment. Results The complete remission rate was 33.3%, the partial remission rate was 33.3%, and the obvious improvement rate was 22.2%. 1 child died and the overall response rate was 88.89%. The ratio of perpherial blood CD4＋ to CD8＋ T cells was increased at 3 month after treatment （P〈0.01）. Five patients suffered from severe infection and one of these patients was died. One patient got chronic infection and needed transfusion. The other 3 patients were recovered. Conclusion ATG combined with CSA therapy is effective in the treatment of children with SAA.