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目的 观察再生障碍性贫血 (AA)实验分组与环孢素A(CSA)疗效的关系 ,探讨指导临床合理选用CSA的实验依据。方法 CFU GM培养采用微量甲基纤维素法。HLA DRB1 15 0 1表达采用聚合酶链反应 -序列特异引物法 (PCR SSP)。结果 CSA治疗组 6个月内有效率明显高于常规治疗组 (P <0 .0 1)。按发病机理分组 ,各组间CSA疗效无差异 (P >0 .0 5 )。体外CSA敏感组CSA疗效高于不敏感组 (P <0 .0 5 )。HLA DRB1 15 0 1阳性表达且对CSA治疗有效者多对CSA依赖 (P <0 .0 1)。CSA体外敏感性和 /或HLA DRB1 15 0 1表达阳性者CSA疗效明显高于这两项结果阴性者 (P <0 .0 5 )。结论 ①CSA是治疗各种类型AA的有效药物 ,较常规治疗疗效提高、疗程缩短。②CSA体外干预实验能较好地预测部分AACSA的疗效 ,其特异性强 ,但敏感性较低。③HLA DRB1 15 0 1阳性表达且CSA治疗有效者则强烈提示CSA依赖 ,为CSA治疗AA在疗程设定上有指导意义。④CSA体外干预实验结合HLA DRB1 15 0 1表达可进一步提高对CSA疗效预测的敏感性。
Objective To observe the relationship between the experimental group of aplastic anemia (AA) and the efficacy of cyclosporin A (CSA) and to explore the experimental basis for guiding the clinical selection of CSA. Methods CFU GM culture using trace methyl cellulose method. HLA DRB1 15 0 1 expression was detected by polymerase chain reaction-sequence-specific primers (PCR SSP). Results The effective rate within 6 months in CSA treatment group was significantly higher than that in routine treatment group (P <0.01). According to the pathogenesis grouping, there was no difference in the efficacy of CSA between groups (P> 0.05). The efficacy of CSA in CSA sensitive group was higher than that of non-sensitive CSA group (P <0.05). HLA-DRB1 15 0 1 was positively expressed and more effective for CSA than CSA (P <0.01). The efficacy of CSA in vitro and / or HLA DRB1 15 01-positive patients was significantly higher than those with negative results (P <0.05). Conclusion ① CSA is an effective drug for the treatment of various types of AA, compared with the conventional treatment efficacy, short course of treatment. ② CSA in vitro intervention experiments can better predict the efficacy of some AACSA, its specificity is strong, but the sensitivity is low. ③HLA DRB1 15 0 1 positive expression and CSA effective treatment is strongly prompted the CSA dependence, CSA treatment of AA in the course of treatment has guiding significance. ④ CSA in vitro intervention experiments combined with HLA DRB1 15 0 1 expression can further improve the sensitivity of CSA efficacy prediction.