ATG联合环孢素A治疗重型再生障碍性贫血的不良反应及其防治对策

目的观察抗胸腺细胞免疫球蛋白（ATG）联合环孢素A治疗重型再生障碍性贫血（SAA）的毒副作用、并发症，探讨其防治对策。方法对2003年1月至2008年7月于采用ATG联合CsA治疗的32例SAA患者的临床资料进行分析。结果32例患者均完成联合免疫抑制治疗，所有患者外周血淋巴细胞计数、血小板计数均于ATG治疗后迅速下降，出现过敏反应11例（34．4％）、血清病9例（28．1％）、肝功能异常21例（65．6％），并有1例出现远期并发症，为骨髓增生异常综合征（MDS）样病态造血。结论ATG联合CsA治疗仍是SAA患者安全、有效的治疗措施，血清病、过敏反应、肝功能损害是其的主要不良反应，但及时给予激素、抗过敏及积极支持治疗可有效控制。

The Side Effects of Combined-treatment with Antithymocyte Globulin and Cyclosporin on Severe Aplastic Anemia and Its Preventing Countermeasures

Objective To observe the side effects, complications of combined-treatment with antithymocyte globulin（ATG） and cyclosporine（CsA） on severe aplastic anemia（SAA） ,and discuss its preventing countermeasures. Methods The clinical data of 32 cases treated with ATG and CsA in our hospital from January, 2005 to July, 2008 were analyzed. Results A total of 32 cases finished the combined immunosuppressive treatment. Peripheral blood lymphocyte counts and platelet counts decreased quickly in all cases after administrantion of ATG. There were 11 patients （34.4%） developed allergic reaction, serum sickness 9 cases （28.1% ）, abnormal liver function 21cases（65.6% ）, and also 1 patient developed myelodysplastic syndrome as the long term complication. Conclusions The combined-treatment with antithymoeyte globulin and cyclosporin is safe and effective for the patients with SAA. The major toxicity of the combined-treatment are serum sickness, allergic reaction and abnormal liver function, which could be controlled effectively by glucocorticosteroids, antiallergic therapy and supportive treatment in time.