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目的 评价重型再生障碍性贫血 (SAA)患者免疫抑制治疗 (IST)后的远期疗效。方法 对 50例IST后存活 3年以上SAA患者长期随访 ,了解其造血重建 (血常规、骨髓象、骨髓活检、造血祖细胞体外培养 )、T淋巴细胞免疫、生活质量及治疗不良反应等情况。结果 IST后各随访时间 (3年、4年、5年以上 )的患者中分别有 81 .3 % (1 3例 )、86 .7% (1 3例 )、89.5 % (1 7例 )血常规正常 ,93 .4 % (1 5例 )、93 .3 % (1 4例 )、94.7% (1 8例 )骨髓象正常 ,37.5 % (6例 )、40 .0 % (6例 )、73 .7% (1 4例 )造血祖细胞培养正常 ;全部患者中有 86 .0 % (43例 )血常规正常、94.0 % (47例 )骨髓象正常、52 .0 % (2 6例 )造血祖细胞培养正常 ,88.0 % (44例 )Karnofsky评分达 1 0 0分。各随访时间共有 31例患者进行了骨髓活检 ,其中 2 6例 (83 .9% )正常 ;37例患者进行了T淋巴细胞亚群检查 ,其中 2 9例 (78.4 % )正常。未发现晚期克隆性疾病。治疗远期不良反应轻微。 2 4例患者的全部随访检查结果正常。结论 部分SAA患者经IST后 ,造血功能、T淋巴细胞免疫、生活质量可完全恢复 ,且无显著不良反应 ,即达治愈
Objective To evaluate the long-term efficacy of immunosuppressive therapy (IST) in patients with severe aplastic anemia (SAA). Methods Fifty patients with SAA who survived more than 3 years after IST were followed up for a long time to understand their hematopoietic reconstitution (blood, bone marrow biopsy, hematopoietic progenitor cell culture in vitro), T lymphocyte immunity, quality of life and adverse reactions. Results 81.3% (13 cases), 86.7% (13 cases) and 89.5% (17 cases) of blood in each follow-up time after IST (3 years, 4 years and 5 years) The patients were normal, 93.4% (93 cases), 93.3% (14 cases), 94.7% (18 cases) with normal bone marrow, 37.5% (6 cases) and 40.0% (6 cases) 73.7% (14 cases) had normal culture of hematopoietic progenitor cells; 86.0% (43 cases) had normal blood routine, 94.0% (47 cases) had normal bone marrow, 52.0% (26 cases) The hematopoietic progenitors were cultured normally, 88.0% (44 cases) with a Karnofsky score of 100. Thirty-one patients underwent bone marrow biopsy at each time of follow-up, with 26 (83.9%) normal; 37 patients underwent T lymphocyte subsets, with 29 (78.4%) normal. No advanced clonal disease was found. Long-term treatment of adverse reactions minor. All 4 follow-up examinations were normal in 24 patients. Conclusion Some patients with SAA after IST, hematopoietic function, T lymphocyte immunity, quality of life can be completely restored, and no significant adverse reactions, that is, up to cure