Liang Li-yan, Zhang Li, Jing Li-ping, Zhou Kang, Wang Xiao-dan, Li Yang, Peng Guang-xin, Li Yuan, Li Jian-ping, Shi Li-Hui, Ye Lei, Fan Hui-hui, Zhang Ping, Chu Yu-lin, Zhang Feng-kui
Institute of Hematology and Blood Diseases Hospital, Tianjin, China.
Zhonghua Xue Ye Xue Za Zhi. 2011 Nov;32(11):766-71.
To evaluate the effects of cyclosporine A (CsA) whole-blood concentration on the early response to immunosuppressive therapy (IST) in severe and very severe aplastic anemia (SAA/VSAA).
Ninety SAA/VSAA patients treated with rabbit antithymocyte globulin (ATG) plus CsA as first line therapy in our hospital were retrospectively analysed. CsA levels between the response group and non-response group, and response rates of patients with variant CsA levels were compared respectively.
(1) There was no significant difference in the beginning unmodified CsA blood concentration between IST responded and non-responded SAA/VSAA patients. The beginning unmodified C(0) 133.91 ug/L in IST 2-month responders was higher than that of 49.9 ug/L in non-responded SAA patients (P = 0.009); (2) The mean CsA C(0) and C(2) levels during the third month following IST were significantly different in responders and non-responders(197.52 µg/L vs 161.49 µg/L, P = 0.024, and 738.76 µg/L vs 615.46 µg/L, P = 0.009), and no significant difference in other periods of IST (P > 0.05); (3) The response rate (87.5%) was significantly higher in patients with CsA C(0) ≥ 200µg/L the third month following IST than those of 55.6% in patients with CsA C(0) 150 - 200 µg/L (P = 0.023) and 59.3% in patients with CsA C(0) < 150 µg/L (P = 0.046), respectively. The response rate was significantly higher of C(2) ≥ 700 µg/L group than that of C(2) < 700 µg/L group (80.5%vs 55.3%, P = 0.012).
The CsA concentration related to the early IST response. The third month CsA concentrations was the most important for the response and maintaining CsA levels with C(0) ≥ 200 µg/L and C(2) ≥ 700 µg/L may improve the response to IST in SAA/VSAA.
评估环孢素A（CsA）全血浓度对重型和极重型再生障碍性贫血（SAA/VSAA）免疫抑制治疗（IST）早期反应的影响。
回顾性分析我院90例接受兔抗胸腺细胞球蛋白（ATG）联合CsA作为一线治疗的SAA/VSAA患者。分别比较反应组和无反应组的CsA水平，以及不同CsA水平患者的反应率。
（1）IST有反应和无反应的SAA/VSAA患者初始未调整的CsA血药浓度无显著差异。IST治疗2个月有反应者的初始未调整C(0)为133.91μg/L，高于无反应的SAA患者的49.9μg/L（P = 0.009）；（2）IST后第三个月反应者和无反应者的平均CsA C(0)和C(2)水平有显著差异（197.52μg/L对161.49μg/L，P = 0.024；738.76μg/L对615.46μg/L，P = 0.009），IST其他时间段无显著差异（P>0.05）；（3）IST后第三个月CsA C(0)≥200μg/L的患者反应率（87.5%）显著高于CsA C(0)为150 - 200μg/L的患者（55.6%，P = 0.）和CsA C(0)<150μg/L的患者（59.3%，P = 0.046）。C(2)≥700μg/L组的反应率显著高于C(2)<700μg/L组（80.5%对55.3%，P = 0.012）。
CsA浓度与IST早期反应相关。第三个月的CsA浓度对反应最为重要，维持CsA水平C(0)≥200μg/L和C(2)≥700μg/L可能改善SAA/VSAA患者对IST的反应。
