| Object:To summarize the effectiveness of antithymus globulin(ATG)/antilymphocyte globulin (ALG) together with herbs of invigorating the kidney in treatment of acute aplastic anemia(AAA), and to analyze the influencial factors of the treatment effect and the survival.Methods:Clinical data and laboratory examination results of87cases with acute aplastic anemia from1992.9-2012.2were analyzed retrospectively to observe the influencial factors on the treatment effect and long-term survival.87cases were treated with ATG/ALG combined with herbs of invigorating the kidney therapy.They were followed up for at least1year.Results:1. Of the77cases,26cases were nearly cured (33.77%),16cases were relieved (20.78%),22cases were improved (28.57%) and13were ineffective (16.88%), The overall effective rate was83.12%.2. After treatment, neutrophilic granulocyte count increased significantly after2weeks.Hemoglobin increased significantly after three months and six months. Reticulocyte count increased significantly after1month.Platelet significantly increased after2months.3.57cases were completely out of blood transfusion. The number of days that25%,50%,75%of the57cases being out of red blood cell and platelet transfusion are32/55,86/102,223/218respectively.4. The onset neutrophilic granulocyte count in ineffective group is significantly lower than that in effective group (P=0.012).The onset neutrophilic granulocyte count has no significant difference between any two of nearly cured group, relived group, improved group and ineffective group except that it in relieved group is significantly higher than that in ineffective group (P=0.03).The effective rate in the group which onset neutrophilic granulocyte count>0.2×109/L is higher than the group which onset neutrophilic granulocyte count≤0.2×109/L (P=0.038). 5. The onset peripheral blood lymphocyte count has no significant difference between effective group and ineffective group (P=0.059). The effective rate in the group which onset peripheral blood lymphocyte count>1.3X109/L is higher than the group which onset peripheral blood lymphocyte count≤1.3X109/L (P=0.009).6. Reticulocyte count in ineffective group is significantly lower than that in effective group (P=0.017). The effective rate in the group which reticulocyte count>10X109/L is higher than the group which reticulocyte count≤10X109/L (P=0.045).7. Of platelet count, course of disease, peripheral blood lymphocyte count on the first day of ATG/ALG medication, the minimum peripheral blood lymphocyte count after ATG/ALG medication, the minimum white blood cell count after ATG/ALG medication, bone marrow non-hematopoietic cell count, CD3+, CD3+CD4+, CD3+CD8+, CD3+CD4+/CD3+CD8+, CD3-CD19+, CD3-CD16+CD56+, CD3+CD16+CD56+, CD3+HLA-DR+, CD3+25+, age and gender, there is no significant difference between ineffective group and effective group (P>0.05)8. Whether serum sickness occurs or not doesn’t affect the treatment effect (P>0.05).If serum sickness occurs, duration of serum sickness in the effecitve group is shorter than that in the ineffective group (P=0.016)9. The treatment effect of using r-ATG-G is better than that of using r-ATG-h (P=0.024).There is no significant difference between other kinds of ATG/ALG.10. Whether it’s HAAA or not doesn’t affect the treatment effect (P>0.05).11. The effective rate in Shen Yang Xu group is higher than that in Shen Yin Xu group and in Ji Lao Sui Ku group (P=0.035, P=0.005). The effective rate between Shen Yin Xu group and Ji Lao Sui Ku group is not significantly different.12. The3-year,5-year,10-year,15-year survival rate are respectively85%,80%,72%,72%.The average survival time is above173±12months. The median survival time is not reached.13. The survival rate of effective group is higher than the ineffective group (P=0.000).Nearly cured group, relieved group and improved group have no significant differences in the survival rate, but they are all higher than the ineffective group.14. The onset neutrophilic granulocyte count, the onset peripheral blood lymphocyte count, reticulocyte count, platelet count don’t affect the survival rate (P>0.05).15. The group which bone marrow non-hematopoietic cell count is>90%has a lower survival rate than the group which bone marrow non-hematopoietic cell count is≤90%(P=0.042).16. The group aged over60years old has the lowest survival rate (P=0.035).The≤20years old group,20-40yeas old group,40-60years old group have no significant differences in survival rate (P>0.05).17. Whether it’s HAAA or not doesn’t affect the survival rate (P>0.05), but further analysis is needed after expanding the sample size.18. The survival rate in Shen Yang Xu group is higher than that in Shen Yin Xu group and in Ji Lao Sui Ku group (P=0.000, P=0.016). The survival rate between Shen Yin Xu group and Ji Lao Sui Ku group is not significantly different.19. The mortality rate is18.18%.Recurrence rate is3.90%.Incidence of clonal disease is10.39%. The mortality rate between HAAA and idiopathic AA has no significant difference (P>0.05), but further analysis is needed after expanding the sample size.Conclusion:1. ATG/ALG combined with herbs of invigorating the kidney therapy in the treatment of acute aplasitc anemia can not only ensure the effective rate, but also reduce the recurrence rate and incidence of clonal disease and raise the survival rate.2. The onset neutrophilic granulocyte count>0.2X109/L, the onset peripheral blood lymphocyte count>1.3X109/L, reticulocyte count>10X109/L can be prognostic factors for treatment effect in acute aplastic anemia.3. Whether serum sickness occurs or not doesn’t affect the treatment effect..If serum sickness occurs, a shorter duration of serum sickness indicates a better treatment effect. 4. The effective rate and survival rate in Shen Yang Xu group are higher than those in Shen Yin Xu group and in Ji Lao Sui Ku group. The effective rate and survival rate between Shen Yin Xu group and Ji Lao Sui Ku group is not significantly different.5. Of platelet count, course of disease, the peripheral blood lymphocyte count on the first day of ATG/ALG medication, the minimum peripheral blood lymphocyte count after ATG/ALG medication, the minimum white blood cells count after ATG/ALG medication, bone marrow non-hematopoietic cell count, CD3+, CD3+CD4+, CD3+CD8+, CD3+CD4+/CD3+CD8+, CD3"CD19+, CD3"CD16+CD56+, CD3+CD16+CD56+, CD3+HLA-DR+, CD3+CD25+, age and gender, these factors are not be taken as prognostic factors for treatment effect in acute aplastic anemia.6. The3-year,5-year,10-year,15-year survival rate are respectively85%,80%,72%,72%. Response to treatment is still the key factor of long-time survival.7. Bone marrow non-hematopoietic cell count>90%predicts a lower survival rate.8. Aged over60years old predicts a lower survival rate.9. Peripheral hemogram doesn’t affect the survival rate. Whether HAAA has a higher mortality rate need further analysis because the sample size is small. |
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