TAM 症例に対するステロイド投与の基準と効果の検討。
対象・方法
2014 ～ 2019 年に当院NICU に入院したシタラビン非適応のTAM 症例を対象に，ステロイド投与の有無で患者 背景を比較し，投与群における，臨床経過の推移も検討した。
結果
TAM18 例中，シタラビン投与2 例を除いた16 例を検討した。ステロイド投与群9 例は非投与群7 例と比べ，在 胎期間は早く（35 vs. 38 週），Apgar スコアは低く（5 分値6 vs. 8 点），胸腹水（4 vs. 0 例）や凝固異常（7 vs. 0 例） が多く，芽球高値（27 vs 4％）であった。投与群においては，生後2 週間程度で芽球は消失し，胸腹水も消失した。 投与群では3 例の死亡例があり，非投与群では死亡例はなかった。
結論
早産児，胸腹水，凝固異常，芽球高値の症状がある場合にステロイドが投与された。ステロイド投与群の臨床経 過は，過去の報告よりも芽球や症状の消失は速く，ステロイドの有効性を示唆する可能性もあるが，自然軽快か治 療の効果かは明らかではなかった。
To evaluate the criteria and efficacy of corticosteroid administration in patients with transient abnormal myelopoiesis （TAM）.
Subjects/Methods
We conducted a retrospective medical record survey of TAM patients admitted to our NICU from 2014 to 2019 who did not have an indication for cytarabine administration. We compared the patients’ baseline characteristics between infants receiving corticosteroid and those not, and described the clinical course of patients who received corticosteroids.
Results
Of the 18 TAM cases, we examined 16 cases after excluding 2 cases treated with cytarabine.
Compared with 7 patients in the non-steroid group, 9 patients in the steroid group had an earlier gestational age（ median of 35 vs. 38 weeks）, a lower Apgar score（3 vs. 8）, more pleural effusion and ascites（ 4 vs. 0）, coagulation abnormalities（7 vs. 0）, and higher blasts（27 vs. 4％）. In the steroid group, 8 patients were intubated and 7 patients were treated with catecholamines, 3 patients died, whereas in the non-steroid group, no patients were intubated and used catecholamines. In the steroid group, blasts, pleural effusion and ascites disappeared within 2 weeks after birth.
Conclusion
In this study, steroids were administered to the patients those with symptoms of pleural effusion, ascites, abnormal coagulation, and high blasts. The clinical improvement of the steroid group was faster than in previous reports in terms of the period of exiting blasts and symptoms. It might indicate the effectiveness of corticosteroids administration；however, it was not clear whether the improvement was spontaneous or due to a steroid treatment.
