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目的探讨抗淋巴细胞球蛋白(ALG)治疗再生障碍性贫血(AA)的疗效。分析ALG不良反应的特点和防治方法。方法对2002年4月-2009年10月本院收治的162例诊断为AA并接受ALG治疗的患儿的临床资料进行回顾性分析,共154例完成了ALG疗程。其中极重型AA(VSAA)34例,重型AAⅠ型(SAAⅠ)103例,重型AAⅡ型(SAAⅡ)7例,中型AA(MAA)10例。结果 154例中,基本治愈62例(40.3%),缓解15例(9.7%),进步28例(18.2%),无效或死亡23例(14.9%),失访26例(16.9%),总有效率为68.2%,复发8例(5.2%)。63例出现变态反应,主要表现为发热和皮疹等。发生时间为用药1~5 d,持续1~4 d。8例因严重变态反应而停止使用ALG,其中1例死于严重的全身血管性变态反应。81例出现血清病反应,主要表现为发热、皮疹和关节肿痛等。发生时间为ALG治疗结束2~14 d,持续1~12 d。有无血清病与ALG疗效差异无统计学意义(P>0.05)。患儿性别、年龄、CD4/CD8、人白细胞Dr抗原与血清病发生率的差异均无统计学意义(Pa>0.05)。结论 ALG治疗AA疗效肯定,变态反应和血清病为治疗中常见的不良反应,应用甲泼尼龙可较好地控制过敏和血清病症状。
Objective To investigate the efficacy of anti-lymphocyte globulin (ALG) in the treatment of aplastic anemia (AA). Analysis of the characteristics of ALG adverse reactions and prevention and treatment methods. Methods A retrospective analysis was performed on the clinical data of 162 children diagnosed with AA and received ALG from April 2002 to October 2009 in our hospital. A total of 154 patients completed the ALG regimen. There were 34 cases of very severe AA (AAAA), 103 cases of SAAⅠ, 7 cases of SAA Ⅱ and 10 cases of medium-sized AA (MAA). Results Among the 154 cases, 62 (40.3%) were basically cured, 15 (9.7%) were alleviated, 28 (18.2%) were improved, 23 (14.9%) were ineffective or dead, 26 (16.9% The effective rate was 68.2% and the recurrence rate was 8 (5.2%). 63 cases of allergic reactions, mainly manifested as fever and rash. Occurrence time for the medication 1 ~ 5 d, lasting 1 ~ 4 d. Eight patients discontinued ALG due to severe allergic reactions, of which 1 died of severe systemic vascular allergy. 81 cases of serum disease reaction, mainly as fever, rash and joint swelling and pain. Occurrence of ALG treatment for 2 ~ 14 d, for 1 ~ 12 d. Serum and ALG no significant difference between the efficacy (P> 0.05). There was no significant difference in the gender, age, CD4 / CD8, the level of human Leukocyte antigen and serum leptospirosis (Pa> 0.05). Conclusion ALG treatment of AA affirmative effect, allergy and serum disease as the treatment of common adverse reactions, the application of methylprednisolone can better control allergy and serum disease symptoms.