造血生长因子治疗成人再生障碍性贫血伴严重感染的疗效观察

摘要

目的：观察造血生长因子对成人再生障碍性贫血伴严重感染患者的疗效，对造血生长因子的安全性及有效性作出评价。方法选取2010年3月至2014年3月治疗的再生障碍性贫血伴严重感染患者80例，采用随机数表法随机分为观察组与对照组，对照组接受免疫抑制治疗（ IST），观察组在对照组基础上给予粒细胞集落刺激因子（ G -CSF）治疗，统计并分析两组治疗的有效率以及治疗1月后感染相关死亡率、克隆性演变发生率，对造血生长因子安全性及有效性作出评价。结果观察组治疗有效率为95.0%（38/40），对照组治疗有效率为80.0%（32/40），观察组治疗有效率明显高于对照组（ P ﹤0.05）。观察组死于肺部感染1例，死于败血症1例，感染相关死亡率为5.0%（2/40）；对照组死于肺部感染2例，死于胃肠道感染1例，死于败血症3例，感染相关死亡率为15.0%（6/40），观察组感染相关死亡率低于对照组，但差异无统计学意义（ P ﹥0.05）。观察组出现骨髓增生异常综合征1例，急性髓系白血病1例，夜间阵发性血红蛋白尿2例，克隆性演变发生率10.0%（4/40）；对照组出现夜间阵发性血红蛋白尿1例，克隆性演变发生率为2.5%（1/40），观察组克隆性演变发生率低于对照组，但差异无统计学意义（ P ﹥0.05）。结论造血因子对于控制成人再生障碍性贫血并发感染具有良好效果，且不明显增高克隆性疾病的发生率，是一种安全有效的治疗方式，值得临床推广使用。%Objective To observe the clinical efficacy of hemopoietic growth factor treatment on adult aplastic anemia patients with severe infection,and to evaluate the safety of the treatment. Methods From March 2010 to March 2014,80 aplastic anemia patients complicated with severe infection were randomly divided into observation group and control group,the control group received immunosuppressive therapy(IST),ob-servation group received the treatment of IST and granulocyte colony - stimulating factor(G - CSF),the effective rate,infection - related mortali-ty,incidence of clonal evolution 1 month after the treatment were analyzed to evaluate the safety and efficacy of the G - CSF treatment. Results The effective rate was 95. 0%(38 / 40)in the observation group,it was 80. 0%(32 / 40)in the control group,The effective rate was significantly higher in the observation group than the control group in the effective rate( P ﹤ 0. 05). One patient died of pulmonary infection and 1 died of sep-sis in the observation group,the infection - related mortality was 5. 0%(2 / 40);two patients died of pulmonary infections,1 died of gastrointesti-nal infections and 3 died of sepsis in control group,the infection - related mortality was 15. 0%(6 / 40). The infection - related mortality was low-er in observation group,but there was no significant difference in the infection - related mortality between the two groups( P ﹤ 0. 05). There were 1 case of myelodysplastic syndrome,1 case of acute myeloid leukemia and 2 cases of paroxysmal nocturnal hemoglobinuria in the observation group,the clonal evolution incidence was 10. 0%(4 / 40). There was 1 case of paroxysmal nocturnal hemoglobinuria in the control group,the clonal evolution incidence was 2. 5%(1 / 40). The clonal evolution incidence was lower in observation group,but there was no significant differ-ence between the two groups( P ﹥ 0. 05). Conclusion Hemopoietic growth factor has a good efficacy in the control of adult aplastic anemia com-plicated with infection,and it does not significantly increase the incidence of clonal disease.