4专题讲座4、SAA治疗进展以及思考.pptVIP

补肾填精生髓可促进干细胞造血； 健脾益气生血可减轻贫血、出血、感染等症状； 活血化瘀生新可改善造血微环境； 中医药的综合作用亦有一定的免疫调节作用； 中西医结合治疗中医在防治西药的毒副作用方面有重要的意义，可起到减毒增效的作用。 SAA治疗开展中西医结合治疗是未来的趋势。 丛培玮.中医治疗慢性再生障碍性贫血的新思路[J].中华中医药学刊,2008,26(3):574-575. 杨同华.再生障碍性贫血的中西医治疗进展[J].世界中西医结合杂志,2007,2(1):180-182. ATG+CSA是目前最为有效的IST方案； HLA相合同胞供者骨髓移植是SAA移植的最佳方案； SAA治疗策略选择 30y,选择HLA匹配同胞供体的allo-BMT； 30~40y，选择ATG+CSA或HLA匹配同胞供体的allo-BMT； 40y，选择ATG+CSA； 中医辨证论治可以改善患者症状，和西药同用可起到减毒增效的作用，中西医结合治疗是未来SAA治疗的方向。 EXJ-PM001/01-4/2009 * Besides compliance with chelation therapy, the iron balance is strongly influenced by the average transfusional iron intake. Free iron has six coordination (chelatable interaction) sites Hexadentate chelators therefore bind more tightly Polydentate chelators are usually higher molecular weight Higher molecular weight pharmaceuticals are generally not orally bioavailable and have poorer pharmacokinetic parameters Deferoxamine Binds to all six sites of iron (1:1 ratio; high-affinity chelator) Poor oral bioavailability – must be infused Rapidly cleared from the body – slow infusion needed The deferoxamine:iron chelate is charged, and does not readily enter or leave cells Bidentate chelators Three molecules are required to chelate free iron Generally less stable binding Lower molecular weight compounds are available Deferiprone Binds iron in a 3:1 deferiprone to iron ratio; not as high affinity as deferoxamine Good oral bioavailability and pharmacokinetics The deferiprone:iron chelate carries no net charge and can penetrate membranes easily Tridentate chelators Two molecules bind and chelate free iron (2:1 binding ratio) Exjade is a novel, high-affinity, low molecular weight compound Deferoxamine-like affinity but lower molecular weight Orally bioavailable; good pharmacokinetics and efficacy in preclinical and clinical testing The deferasirox:iron chelate carries no net charge and, thus, penetrates membranes easily Reference Nick H et al. Curr Med Chem 2003;10:1065–1076 EXJ-PM001/01-4/2009 * Different magnetic resonance i