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目的:评价免疫抑制治疗(immunosuppressive therapy,IST)成人重型再生障碍性贫血患者的近期疗效及长期生存情况,探讨临床因素(年龄、分型、治疗前淋巴细胞百分比、网织红细胞百分比及中性粒细胞计数)与疗效的关系。方法:分析2009年09月至2013年09月接受IST的39例SAA患者1个月、3个月、6个月、1年的有效率及所有患者达到有效的时间,长期随访并计算1年的生存率。用χ2检验比较接受IST治疗者与未接受者的1年总生存率、输注红细胞悬液量及血小板悬液量。用多项logistic回归分析法分析5个临床因素与疗效的关系。结果:39例SAA患者1个月的有效率为29.73%,3个月的有效率为70.27%,6个月的有效率为75.68%,1年的有效率为86.49%;所有患者达到有效的中位时间为61.5 d(10-344 d);接受IST治疗的患者1年生存率为92.31%,与未接受组相比统计学差异明显(P<0.05);治疗组第1年平均月红细胞输注量为1.04(0.13-2.78)×400 ml/月,血小板1.38(0.17-5.10)×200 ml/月,与未接受组比较统计学差异明显(P<0.01);5个临床因素中,年龄、治疗前淋巴细胞百分比及中性粒细胞计数与IST疗效有关(P<0.05)。结论:接受IST治疗患者的1年有效率为86.49%,其长期生存情况优于未接受者,年龄、治疗前淋巴细胞百分比及中性粒细胞计数与IST疗效有关。
OBJECTIVE: To evaluate the short-term efficacy and long-term survival of patients with severe aplastic anemia in immunosuppressive therapy (IST) and to investigate the clinical factors (age, type, percentage of lymphocytes before treatment, percentage of reticulocytes and neutrophils Cell count) and efficacy. Methods: The clinical data of 39 patients with SAA who underwent IST from September 2009 to September 2013 were analyzed at 1 month, 3 months, 6 months and 1 year, and all patients achieved effective time. Long-term follow-up was performed and one year was calculated The survival rate. The χ2 test was used to compare the 1-year overall survival of IST-treated and non-recipients, the volume of red blood cell transfusion, and the amount of platelet transfusion. Multiple logistic regression analysis was used to analyze the relationship between the five clinical factors and efficacy. Results: The effective rate of one month in 39 SAA patients was 29.73%, the effective rate in 3 months was 70.27%, the effective rate in 6 months was 75.68%, and the effective rate in one year was 86.49%. All patients achieved effective The median time was 61.5 days (10-344 days). The 1-year survival rate of patients receiving IST was 92.31%, which was significantly different from that of the non-accepted group (P <0.05) Infusion volume was 1.04 (0.13-2.78) × 400 ml / month, platelet 1.38 (0.17-5.10) × 200 ml / month, which was significantly different from that of the unacceptable group (P <0.01) Age, percentage of lymphocytes before treatment and neutrophil count were related to the efficacy of IST (P <0.05). CONCLUSION: The 1-year effective rate of IST patients is 86.49%. The long-term survival is superior to that of non-recipients. The age, pre-treatment lymphocyte percentage and neutrophil count are related to the efficacy of IST.