目的 观察海曲泊帕联合司坦唑醇片对非重型再生障碍性贫血患者临床疗效、免疫因子等的影响。方法 选取2022年1月—2024年12月南京市第一医院收治的非重型再生障碍性贫血患者81例，依据治疗方式分为对照组（41例）和治疗组（40例）。对照组口服司坦唑醇片，2 mg/次，3次/d。治疗组在对照组基础上口服海曲泊帕乙醇胺片，7.5 mg/d为起始剂量，根据血小板计数（PLT）情况，每2周调整1次剂量，直至维持血小板应答的最低剂量，最高剂量≤15.0 mg/d。两组均治疗6个月。观察两组患者临床疗效，比较治疗前后两组患者PLT，T淋巴细胞亚群指标CD4⁺、CD4⁺/CD8⁺和CD8⁺，血常规指标白细胞计数（WBC）、血红蛋白（HGB）和网织红细胞（RET），复发与恶性克隆演变。结果 治疗后，治疗组血液学反应率（90.00%）高于对照组（70.73%）（P＜0.05）。治疗后，两组治疗1、2、4周后PLT水平均高于同组治疗前（P＜0.05），且治疗组治疗1、2、4周后PLT高于同期对照组（P＜0.05）。治疗后，两组CD4⁺、CD4⁺/CD8⁺表达与治疗前比较显著升高（P＜0.05），而CD8⁺显著降低，且治疗4周后治疗组CD4⁺、CD4⁺/CD8⁺和CD8⁺表达较对照组改善更明显（P＜0.05）。治疗后，两组RET、HGB、WBC表达与治疗前比显著升高（P＜0.05），且治疗4周后治疗组RET、HGB、WBC较对照组升高更显著（P＜0.05）。完成随访的对照组29例，治疗组36例，而治疗组复发率（2.78% vs 27.59%）与恶性克隆演变率（2.78% vs 24.14%）均低于对照组（P＜0.05）。结论 海曲泊帕联合司坦唑醇治疗非重型再生障碍性贫血，利于提高临床疗效、改善患者免疫微环境，促进造血指标恢复，降低治疗后复发风险与恶性克隆演变。

Objective To observe the effect of hetrombopag combined with stanozolol Tablets on the clinical efficacy and immune factors of patients with non-severe aplastic anemia. Methods Patients (81 cases) with non-severe aplastic anemia in Nanjing First Hospital from January 2022 to December 2024 were divided into control (41 cases) and treatment (40 cases) group based on different treatments. Patients in the control group were po administered with Stanozolol Tablets, 2 mg/time, three times daily. Patients in the treatment group were po administered with Herombopag Olamine Tablets on the basis of the control group, 7.5 mg/d was the starting dose, and the dose was adjusted every 2 weeks based on platelet count (PLT) until the lowest dose that maintains a platelet response, and the highest dose was ≤ 15.0 mg/d. Patients in two groups were treated for 6 months. After treatment, the clinical evaluations were evaluated, and the PLT levels, T lymphocyte subsets CD4⁺, CD4⁺/CD8⁺ and CD8⁺, blood routine indicators RET, HGB and WBC, and the evolution of recurrent and malignant clones in two groups before and after treatment were compared. Results After treatment, the OR rate (90.00%) in the treatment group was higher than that in the control group (70.73%, P < 0.05). After treatment, the PLT expression in two groups at 1, 2 and 4 weeks of treatment was higher than that in the same group before treatment (P < 0.05), and the PLT expression in the treatment group at 1, 2 and 4 weeks of treatment was higher than that in the control group during the same period (P < 0.05). After treatment, the expression of CD4⁺ and CD4⁺/CD8⁺ in two groups was significantly increased compared with before treatment, while CD8⁺ was significantly decreased (P < 0.05). After 4 weeks of treatment, the expression of CD4⁺, CD4⁺/CD8⁺ and CD8⁺ in the treatment group was improved more significantly than that in the control group (P < 0.05). After treatment, the expressions of RET, HGB, and WBC in two groups were significantly increased compared with those before treatment (P < 0.05), and the levels of RET, HGB, and WBC in the treatment group were more significant than those in the control group after 4 weeks of treatment (P < 0.05). 29 patients in the control group and 36 patients in the treatment group completed follow-up. The recurrence rate (2.78% vs 27.59%) and malignant clone evolution rate (2.78% vs 24.14%) in the treatment group were lower than those in the control group (P < 0.05). Conclusion The combination of hetrombopag and Stanozolol Tablets in treatment of non-severe aplastic anemia is beneficial to improve the clinical efficacy, improve the immune microenvironment of patients, promote the recovery of hematopoietic indexes, and reduce the risk of recurrence and malignant clone evolution after treatment.

R973

北京白求恩公益基金项目（2024-YJ-156-J-028）