| 唐旭东,张姗姗,麻柔,许勇钢,杨晓红,肖海燕,李柳,胡乃平,郑春梅,刘锋.再生障碍性贫血选用免疫抑制剂或雄激素治疗预测指标的初步研究[J].中国中西医结合杂志,2009,(2):106-110 |
| 再生障碍性贫血选用免疫抑制剂或雄激素治疗预测指标的初步研究 |
| Preliminary Study on Predictors for Selection of Immunosuppressive Therapy or Androgens in Treating Aplastic Anemia Patients |
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| DOI： |
| 中文关键词: 再生障碍性贫血 免疫抑制剂 判别分析 回归分析 |
| 英文关键词:aplastic anemia immunosuppressive agent discriminatory analysis regression analysis |
| 基金项目:国家自然科学基金资助项目(No.30600837) |
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| 中文摘要: |
| 目的研究和评价以外周血T细胞亚群、Th1/Th2、T-bet和GATA-3基因表达及中西医诊断标准为主建立的多变量指标,作为再生障碍性贫血(AA)患者选用免疫抑制剂或雄激素的预测指标。方法采用流式细胞术检测85例AA患者治疗前后外周血T细胞亚群,同时运用实时定量PCR技术检测T-bet和GATA-3基因表达,并以免疫抑制剂和雄激素有效病例做Logistic回归方程及ROC曲线分析。结果(1)按SPSS的ROC曲线模型,设定假阳性率为0.10,取P值为0.832,若P值≥0.832时,判定患者为免疫紊乱状态,应加用免疫抑制疗法(IST)治疗;若P值<0.832时,判定患者为骨髓衰竭状态,应加用雄激素治疗。(2)提出AA在疾病发生发展过程中可大致分为以异常免疫为主和以骨髓衰竭为主两个阶段,以异常免疫为主应加用IST治疗;以骨髓衰竭为主应加用雄激素治疗。结论上述预测方法可判断AA患者处于以异常免疫为主或以骨髓衰竭为主状态,指导免疫抑制剂或雄激素的临床应用。 |
| 英文摘要: |
| Objective To evaluate the potential usefulness of a multivariable model,established mainly upon peripheral T-cell subsets,Th1/Th2,T-bet and GATA-3 gene expressions as well as TCM and Western medical diagnostic criteria,in predicting the selection of immunosuppressive therapy(IST) or androgens in treating patients with aplastic anemia(AA).MethodsPeripheral blood T cell subsets in 85 patients with AA were serially analyzed by flow cytometry before and after treatment,and their T-bet and GATA-3 gene expressions were assessed meantime by Real-time PCR.Then analysis of Logistic regression equation and ROC curves were performed based on the cases responding to IST or androgens.Results(1) According to the logistic equation and ROC curve of SPSS,setting the false positive rate as 0.10,the P value was 0.832.When P≥0.832,patients were judged in the immunosuppressive dominant state,IST should be applied;when P<0.832,it means patients in the bone marrow failure dominant state,androgens should be added.(2) A novel theory is raised by the above-mentioned analysis,which indicated that the genesis and development process of AA could be divided in 2 stages,the abnormal immune dominant stage and the bone marrow failure dominant stage.For treatment of patients in the two stages,IST and androgens is the preference respectively.ConclusionThe multivariable model could be used for indicating which stage the AA patient is in,the abnormal immune stage or the bone marrow failure stage,and thus to guide the proper selection of IST or androgens in clinical practice. |
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