Hinterberger W, Vierhapper H
Second Medical Department, Donau-Hospital, Vienna, Austria.
Wien Med Wochenschr. 1993;143(14-15):380-2.
In the past anabolic steroids were the first-choice treatment for pancytopenic disorders that were often poorly classified. They are now superseded by other more recently developed methods of treatment--for example bone marrow transplantation and immunosuppression. This contrasts to the authors' experience, and to that of many other haematologists, who have noted anabolic steroid-induced responses in patients who were unsuitable for or unresponsive to the new treatments. Anabolic steroids did not, however, demonstrate an obvious effect in recent controlled trials involving patients with aplastic anaemia. Their use with immunosuppressive treatment is currently under investigation. Although anabolic steroids rarely reverse the course of anaemia in a myelodysplastic syndrome, even a slight haemopoietic improvement is desirable. Children with Fanconi's anaemia may benefit from a reduced transfusion requirement. Uraemic patients may experience significant side effects on standard erythropoietin (epo) treatment. There have been no controlled trials comparing epo versus anabolic steroids or epo versus epo in conjunction with anabolic steroids. Data from uncontrolled studies indicate a better response to anabolic steroids in children and females than in men. In spite of the fact that anabolic steroids have been used for almost 30 years, they should be carefully re-evaluated in scientifically controlled trials to test their efficacy and to compare them with the new treatments. Such trials, however, are impeded by the limited knowledge available with regard to pharmacological parameters and optimal treatment schedules.
过去，合成代谢类固醇是全血细胞减少症（这类病症通常分类不明）的首选治疗方法。如今，它们已被其他最新研发的治疗方法所取代，例如骨髓移植和免疫抑制。这与作者以及许多其他血液学家的经验形成了对比，他们注意到，合成代谢类固醇在那些不适合新疗法或对新疗法无反应的患者中会引发反应。然而，在近期涉及再生障碍性贫血患者的对照试验中，合成代谢类固醇并未显示出明显效果。目前正在研究将其与免疫抑制治疗联合使用。尽管合成代谢类固醇很少能逆转骨髓增生异常综合征中的贫血病程，但即便有轻微的造血功能改善也是可取的。范可尼贫血患儿可能会因输血需求减少而受益。尿毒症患者在接受标准促红细胞生成素（epo）治疗时可能会出现显著的副作用。目前尚无对照试验比较epo与合成代谢类固醇，或比较epo与联合使用合成代谢类固醇的epo。非对照研究的数据表明，儿童和女性对合成代谢类固醇的反应比男性更好。尽管合成代谢类固醇已使用了近30年，但仍应在科学对照试验中对其进行仔细重新评估，以测试其疗效并将其与新疗法进行比较。然而，此类试验受到药理学参数和最佳治疗方案方面知识有限的阻碍。
