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环孢素A联合雄激素治疗非重型输血依赖型再生障碍性贫血的预后因素

[Prognostic factors of cyclosporine A combined with androgen in the treatment of transfusion dependent non-severe aplastic anemia].

作者信息

Liu C X, Song L, Zhang L, Jing L P, Zhou K, Zhao X, Fan H H, Peng G X, Li Y, Li J P, Li Y, Ye L, Yang Y, Yang W R, Xiong Y Z, Sun Q, Ru K, Zhang F K

机构信息

State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2020 Mar 14;41(3):234-238. doi: 10.3760/cma.j.issn.0253-2727.2020.03.009.

Abstract

To analyze the prognostic factors of transfusion-dependent non-severe aplastic anemia (TD-NSAA) patients treated with cyclosporine A (CsA) and androgen. Clinical data of 77 consecutive TD-NSAA patients treated with CsA and androgen were retrospectively analyzed between 2010 and 2013. We obtained clinical manifestations and baseline parameters of routine blood test from responders, and compared those with non-responders. All data were analyzed by univariate analysis and multivariate analysis. In 77 patients, there were 43 (55.8%) patients achieved hematological response after 6 months'treatment, and 53 (68.8%) patients got response after 12 months. Univariate analysis showed that platelets baseline was the only factor related to hematological response [19 (6-61) ×10(9)/L 13.5 (5-45) ×10(9)/L, =0.001] after 6 months therapy. After 12 months, the statistical differences were maintained, which were platelets baseline [18 (6-61) ×10(9)/L 10.5 (5-45) ×10(9)/L, <0.001], absolute reticulocytes [0.03 (0.01-0.06) ×10(12)/L 0.029 (0.02-0.06) ×10(12)/L, =0.043], transfusion-dependent of platelet (=0.007) , transfusion-dependent of platelet and erythrocyte (=0.012) . Multivariate analysis showed that platelets baseline could be an independent prognostic factor of hematological response (=0.010 or 0.009) . Cutoff value of platelets by receiver operating characteristic curve was 15.5×10(9)/L. Baseline of higher platelets, higher reticulocyte, and no transfusion dependence of platelet are favorable prognostic factors. When platelets baseline is higher than 15.5×10(9)/L, CsA and androgen regimen is rational.

摘要

分析接受环孢素A(CsA)和雄激素治疗的输血依赖型非重型再生障碍性贫血(TD-NSAA)患者的预后因素。回顾性分析2010年至2013年期间连续77例接受CsA和雄激素治疗的TD-NSAA患者的临床资料。我们获取了缓解者的临床表现和血常规基线参数,并与未缓解者进行比较。所有数据均进行单因素分析和多因素分析。77例患者中,43例(55.8%)在治疗6个月后获得血液学缓解,53例(68.8%)在12个月后获得缓解。单因素分析显示,治疗6个月后,血小板基线是唯一与血液学缓解相关的因素[19(6-61)×10⁹/L对13.5(5-45)×10⁹/L,P=0.001]。12个月后,差异仍然存在,包括血小板基线[18(6-61)×10⁹/L对10.5(5-45)×10⁹/L,P<0.001]、绝对网织红细胞[0.03(0.01-0.06)×10¹²/L对0.029(0.0(此处原文有误,推测为0.02)-0.06)×10¹²/L,P=0.043]、血小板输血依赖情况(P=0.007)、血小板和红细胞输血依赖情况(P=0.012)。多因素分析显示,血小板基线可能是血液学缓解的独立预后因素(P=0.010或0.009)。通过受试者工作特征曲线得出的血小板截断值为1×10⁹/L。较高的血小板基线、较高的网织红细胞以及无血小板输血依赖是有利的预后因素。当血小板基线高于15.5×10⁹/L时,CsA和雄激素方案是合理的。 (注:原文中“10(9)/L 13.5 (5-45) ×10(9)/L”等表述括号使用不规范,翻译时按正确理解翻译,同时“1×10⁹/L”处原文疑似有误,推测为15.5×10⁹/L进行翻译)

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/362a/7357930/8d81ef87d97b/cjh-41-03-234-g001.jpg

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