益气养阴和血方治疗慢性原发免疫性血小板减少症的临床观察  

Clinical Observation of Yiqi Yangyin Hexue Decoction in Treating Patients with Chronic Primary Immune Thrombocytopenia

作　　者：杨冉 姚浩 季建敏[1] 章亚成[1] 林琳[1] 董雯 季鸥[1] 吴萸[1] 朱光荣[1] 张冰 沈群[1] YANG Ran;YAO Hao;JI Jian-min;ZHANG Ya-cheng;LIN Lin;DONG Wen;JI Ou;WU Yu;ZHU Guang-rong;ZHANG Bing;SHEN qun(Department of Hematoloy Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing,210029)

机构地区：[1]南京中医药大学附属医院血液科,南京210029

出　　处：《中国中西医结合杂志》2019年第3期305-309,共5页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：中国中医科学院江苏分院开放课题(No.FY201702)

摘　　要：目的评估益气养阴和血方治疗慢性原发免疫性血小板减少症(cITP)8周的疗效变化。方法纳入江苏省中医院血液科收治的cITP患者76例,口服益气养阴和血方治疗8周,比较治疗前后患者血小板(PLT)计数、出血和激素撤减情况;应用健康调查简表[SF-36量表,包括生理机能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)和精神健康(MH)]、慢性病治疗功能评估疲劳量表(FACIT-F量表)比较健康相关生活质量(HRQoL)和疲劳评分的变化。结果患者治疗总有效率为61.8%(47/76)。与治疗前比较,治疗后患者PLT计数升高,出血评分及激素用量情况改善(P<0.05,P<0.01)。其中治疗前PLT<30×10~9/L的患者总有效率为59%(23/39);PLT≥30×10~9/L的患者总有效率为64.9%(24/37);单用中药患者总有效率为62.5%(20/32);联用激素总有效率为61.4%(27/44)。治疗后患者激素停用15例,减量23例,加量1例,总激素撤减率为86.4%(38/44)。与治疗前比较,治疗后cITP患者SF-36量表中GH、VT、RE和MH分值提高,RP分值降低(P<0.05,P<0.01),FACIT-F量表评分亦升高(P<0.01)。患者性别、年龄、分期、合并症、治疗前PLT、出血评分和联用激素与治疗反应率无关(均P>0.05)。不良反应为腹泻,发生率为2.6%(2/76)。结论益气养阴和血方治疗cITP有助于激素撤减,改善HRQoL及减轻疾病相关的疲劳。Objective To evaluate the 8-week comprehensive effect of Yiqi Yangyin Hexue Decoction(YYHD) in adult patients with chronic primary immune thrombocytopenia(cITP). Methods Totally 76 patients from the department of hematology of Affiliated Hospital of Nanjing University of Chinese Medicine were enrolled. The patients were assigned to receive YYHD for 8 weeks. The platelet(PLT) counts,bleeding,and corticosteroid withdrawal rates of patients were observed before and after treatment. Meanwhile,the changes of the health-related quality of life(HRQoL) and fatigue scores were compared using a Health Survey Profile [SF-36 scale, including physical functioning(PF), role physical(RP), bodily pain(BP), general health(GH),vitality(VT),social functioning(SF),role emotional(RE),and mental health(MH)] and a Chronic Disease Treatment Assessment Fatigue Scale(FACIT-F Scale). Results The total effective rate was 61.8%(47/76). Compared with pre-treatment,there was an increase in PLT count and improvements in bleeding score and corticosteroid dose post-treatment(P<0.05, P<0.01). Specifically, the overall response rate was 59%(23/39) among patients with pre-treatment PLT<30×10^9/L,64.9%(24/37)among patients with pre-treatment PLT≥30×10^9/L,62.5%(20/32)among patients receiving decoction monotherapy,and 61.4%(27/44) among patients receiving combined treatment with corticosteroid. Fifteen patients discontinued corticosteroid,23 reduced corticosteroid dose,and 1 increased dose,accounting for the total corticosteroid dose withdrawal rate of 86.4%(38/44). Among patients with cITP,compared with pre-treatment,there were increases in the GH, VT, RE and MH scores and decreases in the RP score in the SF-36 scale(P<0.05, P<0.01),as well as increase in the FACIT-F score post-treatment(P<0.01). The patients’ gender,age,phases,comorbidities, pre-treatment PLT,hemorrhagic grading,and combination of corticosteroids were not associated with treatment response rates(all P>0.05). The adverse reaction was diarrhea,with an incidence of 2.6%(2/76). Co

关 键 词：血小板减少 益气养阴和血方 健康相关生活质量 疲劳 

分 类 号：R259[医药卫生—中西医结合]