联合免疫抑制剂治疗儿童SAA的不良反应及其对策

目的观察抗胸腺细胞免疫球蛋白（ATG）、环孢素（CsA）和大剂量丙种球蛋白（HDIVIG）联合免疫抑制治疗儿童重型再生障碍性贫血（SAA）的不良反应及其对策。方法采用ATG＋CsA＋HDIVIG治疗SAA儿童22例,对其临床资料进行分析。结果联合免疫抑制治疗22例SAA儿童中,有效率和显效率分别为81.8%（18/22）和72.7%（16/22）,18例病儿发生不同程度感染,3例于ATG用药期间出现过敏反应,3例发生血清病反应,5例出现治疗相关鼻衄（其中2例同时并发肉眼血尿）,5例发生继发性糖尿病,7例出现高血压,8例病人出现低蛋白血症,4例发生低钾、低钙、低镁血症,4例出现牙龈增生,随访期内均未发现克隆性疾病及股骨头无菌性坏死。结论联合免疫抑制治疗作为儿童SAA主要治疗手段之一,临床有效率高,副作用主要为感染、糖皮质激素相关副作用及血清病。感染的综合治疗、糖皮质激素的优化应用对副作用的防治有极其重要的价值。

ADVERSE REACTION AND COUNTERMEASURE OF COMBINED IMMUNOSUPPRESSIVE THERAPY FOR SEVERE APLASTIC ANEMIA IN CHILDREN

Objective To investigate the adverse reaction and its countermeasure of combined immunosuppressive（CIS） therapy with antithymocyte globulin（ATG）,Cyclosporine A（CsA）,and high-dose intravenous immunoglobulin（HDIVIG） for severe aplastic anemia（SAA） in children. Methods Co-therapy of ATG＋CsA＋HDIVIG for 22 children with SAA was undertaken,their clinical records analyzed. Results Of 22 kids treated,the response and excellence rates were 81.8% and 72.7%,respectively.The untoward effects during medication were： various extents of infection（18 cases）;allergic response to TGG（3）;serum sickness reaction（3）;therapy-related epistaxis（5）,two of them accompanied by gross hematuria;secondary diabetes（5）;hypoproteinemia（8）;hypokalemia,hypocalcemia and hypomagnesemia（4）;and gingival hyperplasia（4）.No clonal conditions or aseptic necrosis of femur head were found at follow-up. Conclusion Combined immunosuppressive therapy is one of the main regimens for severe aplastic anemia in children with high response,the side effects were mainly infection,glucocorticoids-related side effects and serum sickness.Co-therapy of infection and optimized application of glucocorticoids are vitally important in the prevention and cure of the untoward events.