抗胸腺细胞球蛋白联合环孢素A免疫抑制治疗儿童重型再生障碍性贫血

发布时间：2018-01-16 13:18

本文关键词：抗胸腺细胞球蛋白联合环孢素A免疫抑制治疗儿童重型再生障碍性贫血　出处：《新疆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：分析儿童重型再生障碍性贫血采用抗胸腺细胞球蛋白(ATG)联合环孢素A(CsA)联合免疫抑制治疗(IST)的疗效及相关影响因素,治疗前后T细胞介导的细胞免疫及B细胞介导的体液免疫的水平变化。方法：回顾性分析11例应用ATG+CSA治疗的重型再生障碍性贫血患儿临床资料,分析其疗效和相关影响因素,统计治疗前后细胞免疫水平和体液免疫水平变化。IST治疗方案为ATG3-5mg/kg.d,静点5天,同时给予地塞米松预防过敏反应及血清病,环孢素5mg/kg.d起始口服,适时调整剂量,加用安特尔及相关对症治疗措施。结果：无效4例,其中1例为第二次ATG治疗患儿,治疗后10个月因严重感染及出血死亡。4例部分缓解,2例完全缓解,共6例有效,总有效率为54%,观察治疗前与治疗后1-6个月外周血象中性粒细胞,血红蛋白及血小板绝对计数,白细胞约3月后恢复,血小板及血红蛋白较白细胞缓慢,约4月后可缓慢恢复,5个月时三系均可达治疗有效状态,6个月时三系达平稳状态,但疗效与年龄、性别、发病与治疗的间隔时间、治疗前外周血中血小板和淋巴细胞及中性粒细胞计数无相关性,p0.05,治疗前后细胞免疫及体液免疫水平比较有显著性差异,p0.05。结论：ATG联合环孢素免疫抑制治疗是儿童重型再生障碍性贫血有效治疗方法,IST方案通过调节细胞免疫和体液免疫水平上起治疗作用,对于远期疗效及影响应进一步研究。
[Abstract]:Objective: to analyze the therapeutic effect of antithymocyte globulin (ATG) combined with cyclosporine (CSA) combined with immunosuppressive therapy on severe aplastic anemia in children and its related influencing factors. Methods: the clinical data of 11 children with severe aplastic anemia treated with ATG CSA were retrospectively analyzed. The therapeutic effect and related influencing factors were analyzed. The changes of cellular and humoral immunity levels before and after treatment. IST regimen was ATG3-5 mg / kg 路d for 5 days. At the same time, dexamethasone was given to prevent allergic reaction and serological disease, 5 mg / kg / d of cyclosporine was given orally initially, the dosage was adjusted at the right time, and Antel and related symptomatic treatment measures were added. Results: 4 cases were ineffective. One case was treated with ATG for the second time. Ten months after treatment, 4 cases died of severe infection and bleeding, 2 cases of partial remission and 2 cases of complete remission, 6 cases were effective, the total effective rate was 54%. The peripheral blood neutrophils, hemoglobin and absolute platelet count were observed before and 1-6 months after treatment. WBC recovered about March, and platelet and hemoglobin were slower than white blood cells. It can recover slowly after April. At 5 months, the three systems can reach the effective state of treatment, and at 6 months the three systems can reach a stable state, but the curative effect and age, sex, the interval between onset and treatment can be achieved. The counts of platelet, lymphocyte and neutrophils in peripheral blood before treatment were not correlated with that of P0.05. there was significant difference in cellular immunity and humoral immunity before and after treatment. Conclusion the combination of ATG and cyclosporine immunosuppressive therapy is an effective treatment for severe aplastic anemia in children. The IST regimen plays a therapeutic role in regulating cellular and humoral immunity levels in children with severe aplastic anemia. Further study should be made on the long-term effects and effects.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.5

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