CsA 联合ATG 或ALG 治疗儿童 SAA 的疗效分析

目的 比较环孢素A（CsA）联合生物种属免疫抑制剂抗人胸腺细胞球蛋白（ATG）与淋巴细胞 球蛋白（ALG）治疗儿童重型再生障碍性贫血（SAA）的疗效及安全性。方法 选取2010 年4 月-2016 年 8 月于河南省濮阳市安阳地区医院收治的93 例SAA 患儿，根据治疗方案分组，对两组患儿的疗效进行比较分 析。结果 治疗3、6、9 及12 个月时，r-ATG 组的OR 分别为58.54%、73.17%、80.49% 和80.49% ；p-ALG 组的OR 分别为46.15%、75.00%、75.00% 和76.92%，组间比较无差异（P >0.05）；在应用r-ATG 或p-ALG 过程中，r-ATG 组应用时过敏所致发热患儿数高于p-ALG 组（P <0.05），r-ATG 组过敏反应总发生率高于 p-ALG 组（P <0.05）；在应用r-ATG 或p-ALG 后，r-ATG 组与p-ALG 组的血清病总发生率分别为60.98% 与61.54%，感染总发生率分别为34.15% 与32.69%，组间比较无差异（P >0.05）；r-ATG 组与p-ALG 组的总 有效率比较无差异（P >0.05）。结论 CsA 分别联合r-ATG 或p-ALG 治疗儿童SAA 在缓解血液学反应方面 效果相当，治疗过程中p-ALG 较r-ATG 在诱发过敏反应方面风险更低。

Comparative analysis of CsA combined with immunosuppressive agents of different species in treatment of children with SAA

Objective To compare the efficacy and safety of cyclosporine A (CsA) combined with immunosuppressive agents of different species in the treatment of children with severe aplastic anemia (SAA). Methods From April 2010 to August 2016, 93 cases of SAA children admitted to Anyang District Hospital were grouped according to the treatment plan. The patients in the r-ATG group (41 patients) received CsA combined with r-ATG and those in the p-ALG group (52 patients) received CsA combined with p-ALG. The treatment effect was compared between the two groups. Results In 3, 6, 9 and 12 months of treatment, the OR of the r-ATG group was 58.54%, 73.17%, 80.49% and 80.49% respectively, the OR of the p-ALG group was 46.15%, 75.00%, 75.00% and 76.92%, there were no significant differences between the two groups (P > 0.05). In the application of r-ATG or p-ALG, the number of children with anaphylaxis fever in the r-ATG group was significantly larger than that in the p-ALG group (P < 0.05), the total incidence of hypersensitivity in the r-ATG group was significantly higher than that in the p-ALG group (P < 0.05). After treatment with r-ATG or p-ALG, the total incidence of serum disease in the r-ATG group and the p-ALG group was 60.98% and 61.54% respectively (P > 0.05), the total incidence of infection was 34.15% and 32.69% respectively (P > 0.05), there was no significant difference in the overall effective rate between the two groups (P > 0.05). Conclusions CsA combined with r-ATG or p-ALG has significant effect in relieving hematologic response for treatment of children with SAA. During treatment, p-ALG has a significantly lower risk in the induction of allergic reactions than r-ATG.