不同剂量丙种球蛋白辅助治疗重型再生障碍性贫血疗效分析

发布时间：2018-04-06 01:25

本文选题：再生障碍性贫血　切入点：丙种球蛋白　出处：《临床儿科杂志》2017年12期

【摘要】：目的分析不同剂量的静脉丙种球蛋白(IVIG)辅助治疗儿童获得性重型再生障碍性贫血(AA)的疗效。方法回顾分析2000年1月至2015年12月应用IVIG辅助免疫抑制治疗的获得性重型AA住院患儿的临床资料。并根据治疗情况分为低剂量组,IVIG 200~400 mg/(kg·d),每4周一次,连用6次;高剂量组,IVIG 1 g/(kg·d),连用2天,每4周1次,连用6次。结果所有患儿随访至2015年12月31日,61例患儿中41例治疗有效,总有效率为67.2%。高剂量组在抗胸腺细胞球蛋白(ATG)治疗后3个月的有效率高于低剂量组,差异有统计学意义(P=0.020)。20例无效患儿IVIG首剂应用距离ATG首剂间隔时间为2.0d(2.0~5.0 d),而41例有效患儿间隔时间为8d(7.0~9.0 d),两组间比较差异有统计学意义(P0.001);在20例无效患儿中有18例ATG与IVIG的使用时间间隔7 d。两组生存率分别为80.0%和87.1%,差异无统计学意义(P0.05)。两组患儿应用抗胸腺细胞球蛋白(ATG)后6个月内,高剂量组严重感染的发生率低于低剂量组,差异有统计学意义(P=0.008)。结论应用免疫抑制治疗的获得性重型AA患儿,加用高剂量IVIG辅助治疗可使早期反应率增加,但并未增加其远期有效率、治愈率及5年生存率;可减少严重感染率,但未能减少总感染率及感染相关死亡率。
[Abstract]:Objective to analyze the efficacy of intravenous gamma globulin (IVIGG) in the treatment of acquired severe aplastic anemia (AA) in children.Methods from January 2000 to December 2015, the clinical data of patients with severe AA who were treated with IVIG adjuvant immunosuppressive therapy were retrospectively analyzed.According to the treatment condition, the patients were divided into low dose group and high dose group for 4 weeks and 6 times, respectively, for 2 days, once every 4 weeks, and for 6 times.Results 41 of 61 cases were followed up to December 31, 2015. The total effective rate was 67.2%.The effective rate of high dose group was higher than that of low dose group 3 months after antithymocyte globulin therapy.The difference was statistically significant (P < 0. 020). The interval between the first dose of IVIG and the first dose of ATG was 2.0d(2.0~5.0 DX, while that of 41 effective children was 8d(7.0~9.0 DX, the difference between the two groups was statistically significant (P 0. 001), and 18 out of 20 children were ineffective.The time interval between ATG and IVIG is 7 days.The survival rates of the two groups were 80.0% and 87.1%, respectively. There was no significant difference between the two groups (P 0.05).The incidence of severe infection in the high dose group was lower than that in the low dose group within 6 months after the application of antithymocyte globulin (ATG), and the difference was statistically significant.Conclusion the adjuvant therapy of high dose IVIG can increase the early response rate, but does not increase the long-term effective rate, cure rate and 5-year survival rate, and reduce the severe infection rate in the children with acquired severe AA treated with immunosuppressive therapy.However, it failed to reduce the total infection rate and infection-related mortality.
【作者单位】：同济大学附属同济医院儿科;
【基金】：国家自然科学基金面上项目(No.81670119) 上海市卫生和计划生育委员会面上项目(No.201540164)
【分类号】：R725.5

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