ABSTRACT
Aplastic anemia is a severe hematological disease characterized by bone marrow failure and pancyto-penia.Immunosuppressive therapy(IST)with antithymocyte globulin(ATG)and cyclosporine A(CSA)is the first -line treatment for patients who lack an HLA -matched sibling.One third of the patients has no response to IST and the high risk of ATG -related adverse effects may lead to ATG -related death.So it is necessary to explore the predictive marker of response to IST.A defined predictive marker may make the selection of treatment more reasonable and further improve the long -term efficacy.The relevant literatures were analyzed and summarized in recent years,in order to pro-vide a reference for clinical treatment and a baseline for prospective studies.
ABSTRACT
Objective To investigate the therapeutic effect of Budesonide inhalation for the children with chronic cough after Mycoplasma pneumoniae infection and its influence on the improvement of sleep quality.Methods One hundred children with chronic cough after Mycoplasma pneumoniae infection treated at Shsnghai Tongji Hospital(Tongji Hospital Affiliated to Tongji University) were selected from June to December 2016,and they were randornly divided into the Budesonide group and the Azithromycin group.The Budesonide group received the Budesonide inhalation,the atomized inhalation 1 mg each time,2 times a day,for 3 consecutive days,and 3 days later,they received ato-mization treatment once a day,for a total of 7 days.The patients in the Azithromycin group were given oral the Azithromycin treatment 10 mg/(kg · d) for 3 days.The efficacy and sleep scores of 2 groups were compared during the period.Results The cure rate of cough in the Budesonide group[8.0％ (4/50 cases),32.0％ (16/50 cases),38.0％ (19/50 cases)]was higher than those in the Azithromycin group[0 (0/50 cases),4.0％ (2/50 cases),6.0％ (3/50 cases)] during 3,7,14 days,and the differences were all statistically significant (x2 =4.167,13.279,14.918,all P ＜0.05).The improvement rates of cough in the Budesonide group [28.0％ (14/50 cases),28.0％ (14/50 cases),26.0％ (13/50 cases)]were higher than those in the Azithromycin group[10.0％ (5/50 cases),10.0％ (5/50 cases),8.0％ (4/50 cases)] in treatment 3,7,14 days,and the differences were all statistically significant (x2 =5.263,5.263,5.741,all P ＜ 0.05).Nighttime sleep scores returned to normal ratio and improvement rates during 3,7,14 days in the Budesonide group [8.0％ (4/50 cases),32.0％ (16/50 cases),42.0％ (21/50 cases);30.0％ (15/50 cases),30.0％ (15/50 cases),30.0％ (15/50 cases)],which were significantly higher than those in the Azithromycin group [0(0/50 cases),4.0％ (2/50 caes),6.0％ (3/50 cases);12.0％ (6/50 cases),12.0％ (6/50 cases),10.0％ (5/50 cases)],and the differences were all statistically significant (all P ＜ 0.05).Conclusions The inhalation of Budesonide can effectively treat chronic cough in children with Mycoplasma pneumoniae infection in children,and significantly improve the quality of sleep.Chronic cough after Mycoplasma pneumoniae infection may be related to airway hyperresponsiveness due to nonspecific inflammation.Inhaled corticosteroids should be selected rather than anti infective therapy.
ABSTRACT
Objective To analyze the efficacy of different doses of intravenous immunoglobulin (IVIG) in the treatment of acquired severe aplastic anemia (AA) in children. Methods The clinical data of hospitalized children with severe AA who received adjuvant immunosuppressive therapy of IVIG from January 2000 to December 2015 were retrospectively analyzed. According to different doses of treatment, the children were divided into low dose group ( IVIG 200-400 mg/ (kg·d) once every 4 weeks for 6 times), high dose group (IVIG 1 g/ (kg·d ) x 2 days once every 4 weeks for 6 times). Results All the children were followed up until December 31, 2015. Among the 61 children, it was effective in 41 children and total effective rate was 67.2%. The effective rate of anti thymocyte globulin (ATG) treatment in high dose group was higher after 3 months than that of low dose group, and there was statistical difference (P=0.020). The interval between first dose of IVIG and first dose of ATG in 20 cases of ineffectiveness was 2.0 (2.0-5.0) d, while that in 41 cases of effectiveness was 8.0 (7.0-9.0) d, and the difference is statistically significant (P<0.001); Among the 20 ineffective children, 18 children had the interval <7 day. The survival rates of the two groups were 80% and 87.1%, respectively, and there was no difference between two groups (P>0.05). The incidence of severe infections in the high-dose group was lower than that in the low-dose group after the use of ATG for 6 months, and there was statistical difference (P=0.008). Conclusions High dose of IVIG therapy can increase the early response rate in children with acquired severe AA, but it does not increase the long-term effectiveness, cure rate and 5 year survival rate. In addition, it can reduce the severe infection rate, but cannot reduce the total infection rate and infection related mortality rate.