补肾活血法与益气补肾法治疗慢性再生障碍性贫血的疗效比较  

A clinical study on comparison of therapeutic effect of tonifying kidney and activating blood circulation method to that of replenishing qi and tonifying kidney method for treatment of patients with chronic aplastic anemia

作　　者：刘永华[1] 江锦红[1] 吴迪炯[2] 沈一平[2] 曲志刚[1] 马光丽[1] 章俏雷[1] 汪笑秋[1] 王晓丽[1] 胡致平[2] 周郁鸿[2] 方炳木[1] 

机构地区：[1]温州医科大学附属第六医院浙江省丽水市人民医院血液科,浙江丽水323000 [2]浙江中医药大学附属第一医院浙江省中医院血液科,浙江杭州310006

出　　处：《中国中西医结合急救杂志》2015年第3期234-238,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家中医药行业科研专项基金项目（201107001）;浙江省重大疾病科技创新平台项目（2009ZDJB01-07）;浙江省丽水市科技局项目（2012JYJB79）;浙江省丽水市人民医院萌芽基金（2012MY13）

摘　　要：目的比较补肾活血与补肾益气两种方法治疗慢性再生障碍性贫血（慢性再障）的疗效，探讨以补肾为基础的中药复方在慢性再障治疗中的优势。方法采用前瞻性研究方法，将90例慢性再障患者按随机数字表法分为补肾活血组、补肾益气组和西药对照组，每组30例。3组均给予对症支持治疗；西药对照组给予环孢素A3～5mg·kg-1·d-1，安雄80mg、每日2次或司坦唑醇2mg、每日3次口服；补肾活血组在对照组治疗基础上给予金匮肾气丸加减合活血中药（熟地黄15g，肉桂3g，淡附片4g，补骨脂12g，淫羊藿8g，杜仲12g，山茱萸15g，淮山药15g，枸杞子15g，制首乌12g，黄精15g，当归10g，赤芍10g，桃仁6g，鸡血藤10g），每日1剂；补肾益气组在对照组治疗基础上给予金匮肾气丸加减合益气中药（黄芪30g，炒白术10g，党参12g，熟地黄15g，肉桂3g，淡附片4g，补骨脂12g，淫羊藿8g，杜仲12g，山茱萸15g，淮山药15g，枸杞子15g，制首乌12g，黄精15g），每日1剂，3组均治疗6个月后观察血象、外周血淋巴细胞亚群、γ-干扰素（IFN-γ）、肿瘤坏死因子-α（TNF—α）的变化及临床疗效。结果3组治疗后白细胞计数（wBc）、血红蛋白（t／b）及血小板计数（PLT）均较治疗前明显增加[西药对照组：wBc（×109／L）：3．58±1．04比2．35±0．94，Hb（g／L）：83．60±22．31比65．43±23．20，PLT（×10^9／L）：60．43±30．54比36．84±20．12；补肾活血组：WBC（×10^9／L）：4．05±1．62比2．40±1．24，Hb（g／L）：95．25±19．64比68．57±26．59，PLT（×10^9/L）：72．65±37．76比40．23±20．01；益气补肾组：wBC（×10^9／L）：3．87±1．47比2．19±1．20，Hh（g/L）：89．64±27．43比62．11±20．21，PLT（×10^9／L）：69．54±40．21比38．67±18．34，均P〈0．05]；而3组间治疗前后比较差异均无统计学意义（均P〉0．05）；3组治疗后CD4�Objective To compare the therapeutic effect of tonifying kidney and activating blood circulation method to that of replenishing qi and tonifying kidney method in treatment of patients with chronic aplastic anemia （CAA）, and to approach the advantage of Chinese medicine prescription based on tonifying kidney for treatment of CAA. Methods A prospective study was conducted. Ninety patients with CAA were randomly divided into tonifying kidney and activating blood circulation group, replenishing qi and tonifying kidney group and western medicine control group by a random number table, 30 cases in each group. All the patients in the three groups were given symptomatic treatment. And the patients in western medicine control group were treated with cyclosporine A 3 - 5 mg kg-1 d-1, andriol 80 mg twice daily or stanozolol 2 mg thrice a day orally. The patients in tonifying kidney and promoting blood circulation group were treated, on the basis of treatment in control group, additionally with modified Jinkui Shenqi pills plus Chinese herbal medicine for promoting blood circulation （Rehmanniae Radix Praeparata 15 g, Cinnamomi Cortex 3 g, Aconiti lateralis Radix Praeparata 4 g, Psoraleae Fructus 12 g, Epimedii Herba 8 g, Eucommiae Cnrlex 12 g, Corni Fructus 15 g, Dioscoreae Rhizoma 15 g, Lycii Fruetus 15 g, Polygoni Multiflori Radix Praeparata 12 g, Polygonati Rhizoma 15 g, Angelicae Sinensis Radix 10 g, Paeoniae Radix Rubra 10 g, Persicae Semen 6 g, Spatholobi Caulis 10 g）, one dose a day. The patients in replenishing qi and invigorating kidney group were treated, on the basis of treatment in the control group, additionally with modified Jinkui Shenqi pills plus traditional Chinese medicine for replenishing qi （Astragali seu Hedysari Radix 30 g, Atractylodis Macrocephalae Rhizoma Tostum 10 g, Codonopsis Radix 12 g, Rehmanniae Radix Praeparatal5 g, Cinnamomi Cortex 3 g, Aconiti lateralis Radix Praeparata 4 g, Aconiti lateralis Radix Praeparata 12 g, Epimedii Herba 8 g, Eucommiae Cortex 15 g, Corni Fruetus 15 g, Di

关 键 词：再生障碍性贫血 补肾活血法 益气补肾法 环孢菌素A 中西医结合疗法 

分 类 号：R556.5[医药卫生—血液循环系统疾病]