The Apeutic Effects Of Combined Immunosupressive Therapy On Severe Aplastic Anemia In Children

Objective To investigate the influence on immune functions and theapeutic effects of combined immunosuppressive therapy in children with severe aplastic anemia.Methods All children with SAA were given tow kinds of CIS therapy,the groupⅠ(7 cases) with HDIVIG,HDMP,CsA and ATG;the groupⅡ(16 cases) with CsA,HDIVIG,HDMP.Flow cytometry was used to detect the counts of CD3~+,CD4~+,CD8~+,CD(16~+56)~+from peripheral bloods in the children with aplastic anemia and in 35 normal healthy children.Protein analysor was used to detect the contents of IgA,IgG,IgM and hemogram,bone marrow smear at the same time.Results①There was significant improvement of the count of myelogram,peripheral bloods WBC,Hb and PLT(P＜0.01) for the SAA between before and after treatment.The groupⅠwas much better the groupⅡ,which the counts of peripheral bloods WBC,Hb and PLT and the effective ratio of groupⅠwas better significant than the groupⅡ(t'=2.20,t=2.33,t'=2.88,x~2=4.40,all of them P＜0.05).②In the groupⅠ,before treatment,there were no significant differences of the counts of CD3~+,CD4~+,CD8~+,CD4~+/CD8~+ comparing with those of normal control group(t'=0.44, t'=1.11,t'=0.67,t=1.33,all of them P＜0.05);but after treatment,those of CD3~+,CD4~+,CD4~+/CD8~+ were significant lower than those of normal group(t'=2.45, t'=3.22,t=2.20,all of them P＜0.05);no was that of CD8~+.There were no significant differences of the counts of CD3~+,CD4~+,CD8~+,CD4~+/CD8~+ between the untreated and treated children with SAA in the groupⅠ(t value was 1.1;0.32;0.81;0.16 respectively,all of them P＞0.05).In the 11 cases children with SAA-Ⅱin the groupⅡ,before treatmend,there was no significant difference of the count of CD3~+ compare with those of normal control group(t'=0.51,P＞0.05);but the counts of CD4 ~and CD4~+/CD8~+ were significant lower than those of normal group(t=5.33, t'=7.21,all of them P＜0.01),the count of CD8~+ was significant higher than that of normal group(t=16.29,P＜0.01).After treatment,in the 11 cases with SAA-Ⅱin the groupⅡ,there was no significant difference of the counts of CD3~+ compare with that of normal control group(t=1.75,P＞0.05);but those of CD4~+,CD4~+/CD8~+ were significant lower than that of those of normal group and that of CD8~+ was higher significant than that of that of normal group(t=3.18,t'=4.05,t=11.50,all of them P＜0.01).In the 11 cases children with SAA-Ⅱin the groupⅡ,there were no significant differences of the counts of CD3~+,CD4~+,CD8~+,CD4~+/CD8~+ between treated and untreated cases(t value was 1.86;0.45;1.83;1.95 respectively,all of them P＞0.05).After treatment,the counts of CD3~+,CD4~+,CD8~+ of the children in the groupⅠwas significant lower than those of the 11 cases of children in groupⅡ(t value was 4.24;5.88;5.53 respectively all of them P＜0.05),but there was no significant difference of the ratio of CD4~+/CD8~+(t=0.54,all of them P＞0.05).③Before treatment,the count of NK of the children in the two groups were all higher significant than that of normal group(t=7.80,t=5.48,all of them P＜0.01).After treatment,in the groupⅠ,there was no significant difference of the counts of NK of the children between in the groupⅠand in the normal group(t=0.65,P＜0.05).However,the SAA-Ⅱin the groupⅡ,the counts of NK was higher significant than that of normal group(t=3.83,P＜0.01).The counts of NK of the children in groupⅠafter treatment was lower significant than before treatment(t=2.83,P＜0.05),and there was no significant difference of that in the groupⅡbetween before treatment and after treatment(P＜0.05).After treatment,The counts of NK of the children in groupⅠwas lower significant than that in the groupⅡ(t=2.12,P＜0.05).④Before treatment,There was no significant difference of the counts of CD19~+ between treated and untreated children with SAA in the two groups(P＞0.05).After treatment,the counts of CD19~+ in the groupⅠwas higher significant than that of normal group(t=3.69,P＜0.05),and there was no significant difference of that in the groupⅡ(t=0.66,P＞0.05).⑤There were no significant difference of the content of IgA,IgG,IgM between the treated and untreated children with SAA and normal group(P＞0.05).Conclusions①The abnormality of immunologic functions,especially the cells immunologic functions,plays an important role in the pathogenes is of AA.②The change of immunologic functions of SAA-Ⅰis lower than that of SAA-Ⅱ,and the immunologic functions of SAA-Ⅰrecovers easilier than that of SAA-Ⅱ.③Combined immunosuppressive therapy is a very effective treatment in childhood with SAA,which ATG is more excellent.④There is still the abnormality of the cells immunologic functions after treatment by CIS.