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目的:观察补肾凉血中药联合强烈免疫抑制剂治疗重型再生障碍性贫血(SAA)的临床疗效。方法: 11例患者采用补肾凉血中药联合抗胸腺细胞球蛋白(ATG)、环孢素A(CSA)治疗。治疗每1～2天查血常规及网织红细胞(Ret)1次,此后根据情况每周1～2次;CSA浓度开始每周查1次,稳定后1月查1次;3月、6月时全面复查血象、骨髓象、溶血等,以后每3月复查。结果:随诊1年以上7例,基本治愈3例,缓解、明显进步各1例,无效1例,1例患者免疫治疗后15天因颅内出血死亡;另4例治疗未达1年,其中2例明显进步, 1例缓解,1例无效。总有效率为72.73%。治疗前后白细胞(WBC)、Ret、血红蛋白(Hb)均较治疗前显著改善,差异有显著性意义(P<0.05)。血小板(BPC)亦较治疗前有明显提升,但差异无显著性意义(P>0.05)。有效病例于1～2月血象开始改善,多数先为Ret上升,继之Hb上升,随后WBC上升,BPC上升最晚亦最慢。治疗前所有患者均行多部位穿刺,除2例骨髓增生尚活跃外余均增生减低或重度减低;治疗后3月骨髓增生为活跃或明显活跃者5例,增生低下者6例;6月后骨髓增生为活跃或明显活跃者8例,增生低下者3例。结论:补肾凉血中药联合ATG、CSA治疗SAA,可明显改善症状、调节免疫、增强患者的抗病能力、减少强烈免疫抑制剂的不良反应、延长输血间歇期。
Objective: To observe the clinical efficacy of Bushen Liangxue combined with strong immunosuppressive agents in the treatment of severe aplastic anemia (SAA). Methods: Eleven patients were treated with Bushen Liangxue combined with anti-thymocyte globulin (ATG) and cyclosporin A (CSA). Treatment every 1 to 2 days to check blood and reticulocyte (Ret) 1 times, then according to the situation 1 to 2 times a week; CSA concentration began to check once a week, 1 month after the stable check; March, 6 Month comprehensive review of blood, bone marrow, hemolysis, etc., after every March review. Results: Followed up for more than one year in 7 cases, basically cured in 3 cases, relieved, markedly improved in 1 case, ineffective in 1 case, 1 patient died of intracranial hemorrhage 15 days after immunotherapy; in 4 cases less than 1 year 2 cases significantly improved, 1 case of remission, 1 case is invalid. The total effective rate was 72.73%. The WBC, Ret, hemoglobin (Hb) before and after treatment were significantly improved compared with before treatment, the difference was significant (P <0.05). Platelet (BPC) also significantly improved compared with before treatment, but no significant difference (P> 0.05). Effective cases in January and February blood began to improve, most of the first Ret increased, followed by Hb increased, followed by the rise of WBC, BPC rose at the latest and the slowest. All patients underwent multi-site puncture before the treatment, except for 2 cases of myeloproliferative hyperplasia still active outside the proliferation were reduced or severely reduced; 3 months after treatment of bone marrow hyperplasia was active or significantly active in 5 cases, 6 cases of hyperplasia; after 6 months Bone marrow hyperplasia was active or significantly active in 8 cases, 3 cases of hyperplasia. Conclusion: Bushen Liangxue combined with ATG and CSA can improve the symptoms, regulate the immune system, enhance the disease resistance of patients, reduce the adverse reaction of strong immunosuppressive agents and prolong the interval of blood transfusion.