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目的观察抗胸腺细胞球蛋白(ATG)联合环孢素治疗重型再生障碍性贫血(SAA)的疗效及安全性。方法回顾性分析本院2009年1月-2010年3月收治的14例应用ATG联合环孢素治疗的儿童SAA的疗效及不良反应。14例患儿均采用ATG联合环孢素治疗,ATG用量为5mg·kg-1·d-1,静脉滴注,共5d,应用ATG前清除感染灶;同时静脉滴注甲泼尼龙2～3mg·kg-1·d-1,以减轻变态反应;环孢素的起始用量为3～5mg·kg-1·d-1,根据血药质量浓度调整环孢素用量,维持环孢素血药谷质量浓度为100～200μg·L-1;辅以成分输血、粒细胞集落刺激因子及抗感染治疗。结果 14例患儿中有效10例(71.43%),无效4例(28.57%);14例患儿中骨髓增生活跃者8例,其中有效7例(87.5%),无效1例(12.5%);骨髓增生低下者6例,有效3例(50.0%),无效3例(50.0%);在14例应用ATG治疗的患儿中,1例患儿在治疗过程中出现变态反应,2例在应用ATG2周左右出现血清病;1例患儿治疗过程中因PLT过低、颅内出血死亡。结论 ATG联合环孢素治疗儿童SAA有效,且相对安全,尤其是骨髓增生尚活跃者,有可能达到治愈。
Objective To observe the efficacy and safety of anti-thymocyte globulin (ATG) and cyclosporine in the treatment of severe aplastic anemia (SAA). Methods A retrospective analysis of our hospital from January 2009 to March 2010 14 patients treated with ATG combined cyclosporine in children with SAA efficacy and adverse reactions. 14 cases of children were treated with ATG combined with cyclosporine, ATG dose of 5mg · kg-1 · d-1, intravenous infusion, a total of 5 days, before the application of ATG to clear the infected foci; intravenous methylprednisolone 2 ~ 3mg · Kg-1 · d-1, to reduce the allergic reaction; cyclosporine initial dose of 3 ~ 5mg · kg-1 · d-1, according to the concentration of cyclosporine plasma concentration adjustment, maintain cyclosporine blood Medicine valley mass concentration of 100 ~ 200μg · L-1; supplemented by component blood transfusion, granulocyte colony stimulating factor and anti-infective treatment. Results Of the 14 cases, 10 cases were effective (71.43%) and 4 cases (28.57%) were ineffective. Among 14 cases, 8 cases were active in bone marrow hyperplasia, of which 7 cases were effective (87.5%) and 1 case ; 6 cases of low myelosuperiority were effective in 3 cases (50.0%), 3 cases were ineffective (50.0%); in 14 cases of children treated with ATG, 1 case of allergic reactions in the course of treatment, 2 cases in Application of ATG2 weeks or so appear serum disease; 1 case of children with PLT treatment due to low, intracranial hemorrhage death. Conclusions ATG plus cyclosporine is effective and safe for the treatment of SAA in children, especially those with active myeloproliferation, and it is possible to achieve cure.