基于“阴火”理论探讨益气摄血方治疗免疫性血小板减少症临床意义  

The Clinical Significance of Yiqi Shexue Decoction in the Treatment of Immune Thrombocytopenia Based On The Theory Of“Yin Fire”

作　　者：王明镜[1] 孙妍 朱世荣 丁晓庆[2] 谌海燕[2] 许勇钢[1] 王雪莹 胡晓梅[1] WANG Ming-jing;SUN Yan;ZHU Shi-rong;DING Xiao-qing;CHEN Hai-yan;XU Yong-gang;WANG Xue-ying;HU Xiao-mei(Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091;Dongfang Hospital,Beijing University of Chinese Medicine,Beijing 100078)

机构地区：[1]中国中医科学院西苑医院,北京100091 [2]北京中医药大学东方医院,北京100078

出　　处：《世界中西医结合杂志》2020年第11期1977-1982,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：国家重点基础研究发展计划(973计划)(2015CB554403)。

摘　　要：目的基于"阴火"理论,探讨益气摄血方治疗气不摄血证免疫性血小板减少症(Immune thrombocytopenia,ITP)的临床意义。方法选取2018年3月—2018年12月期间在中国中医科学院西苑医院血液科门诊就诊的ITP患者33例,给予益气摄血方颗粒治疗,研究周期为8周。应用Aim Plex流式高通量多细胞因子检测法检测炎症细胞因子。疗效评价指标包括血小板计数、激素撤减比例、出血评分、Karmofsky体力评分(KPS)、功能疲劳量表(FACIT-F)以及炎症细胞因子表达水平。结果与治疗前相比较,治疗后患者PLT显著升高[44(17~96)vs 35(9~56),P<0.05];出血评分在0、1、2分患者比例分别由治疗前3.03%(1/33)、45.45%(15/33)、51.52%(17/33)变化为治疗后93.93%(31/33)、3.03%(1/33)、3.03%(1/33)(P<0.05);患者激素用量显著下降,用量在0 mg/d、0~15 mg/d、15~30 mg/d范围患者比例分别由治疗前24.24%(8/33)、18.18%(6/33)、57.58%(19/33)变化为治疗后51.52%(17/33)、33.33%(11/33)、15.15%(5/33)(P<0.05);患者体力状况显著改善,KPS评分分别在70、80、90、100分患者比例分别由治疗前69.7%(23/33)、27.27%(9/33)、3.03%(1/33)、0(0/33)变化为治疗后6.06%(2/33)、3.03%(1/33)、69.7%(23/33)、21.21%(7/33)(P<0.05);疲劳显著缓解,FACIT-F评分由治疗前(13.13±4.37)显著升高至治疗后(31.34±8.98)(P<0.05)。促炎因子IFN-γ(4.80±1.08 vs 5.34±0.77)(P<0.05)、TNF-α(2.81±1.10 vs 7.09±4.20)(P<0.05)、IL-17(171.40±61.70 vs 224.77±86.60)(P<0.05)、IL-22(6.90±2.70 vs 24.08±5.30)(P<0.05)表达显著减少;抑炎因子TGF-β(23246±1549 vs 11187±1430)(P<0.05)、IL-10(5.35±1.9 vs 4.3±1.26)(P<0.05)、IL-4(5.47±2.61 vs 3.4±0.9)(P<0.05)表达显著增加。结论益气摄血方通过益气去除"阴火",以改变机体炎性状态,从而提升血小板、防治出血、撤减激素、改善体能以及缓解疲劳状态而达到治疗作用。同时"阴火"理论在治疗气不摄血证ITP中具有指导意义。Objective Based on the theory of"yin and fire",to explore the clinical significance of Yiqi Shexue Decoction in the treatment of Immune thrombocytopenia(ITP).Methods A total of 33 patients with ITP from the Department of Hematology,Xiyuan Hospital,China Academy of Chinese Medical Sciences from March 2018 to December 2018 were treated with Yiqi Shexue Fang granules.The study period was 8 weeks.The Aim Plex flow cytometric high-throughput multi-cytokine detection method was used to detect inflammatory cytokines.Efficacy evaluation indicators include platelet count,hormone withdrawal ratio,bleeding score,Karmofsky physical strength score(KPS),functional fatigue scale(FACIT-F)and inflammatory cytokine expression level.The results were compared with those before treatment.Results After treatment,the PLT of patients was significantly increased[44(17~96)vs 35(9~56),P<0.05];the proportion of patients with bleeding scores of 0,1,and 2 was 3.03 respectively before treatment%(1/33),45.45%(15/33),51.52%(17/33)changed to 93.93%(31/33),3.03%(1/33),3.03%(1/33)after treatment(P<0.05);The dosage of hormones in patients decreased significantly,and the proportion of patients in the range of 0 mg/d,0-15 mg/d,and 15-30 mg/d increased from 24.24%(8/33)and 18.18%(6)before treatment./33,57.58%(19/33)changed into 51.52%(17/33),33.33%(11/33),15.15%(5/33)(P<0.05)after treatment;the patient’s physical status was significantly improved,The proportion of patients with KPS scores of 70,80,90,and 100 points changed from 69.7%(23/33),27.27%(9/33),3.03%(1/33),and 0(0/33)before treatment.After treatment 6.06%(2/33),3.03%(1/33),69.7%(23/33),21.21%(7/33)(P<0.05);fatigue was significantly relieved,FACIT-F score was changed from before treatment13.13±4.37 significantly increased to 31.34±8.98 after treatment(P<0.05).Pro-inflammatory factor IFN-γ(4.80±1.08 vs 5.34±0.77)(P<0.05),TNF-α(2.81±1.10 vs 7.09±4.20)(P<0.05),IL-17(171.40±61.70 vs224.77±86.60)(P<0.05),IL-22(6.90±2.70 vs 24.08±5.30)(P<0.05)expression was significantly reduced;anti-in

关 键 词：免疫性血小板减少症 阴火理论 益气摄血方 炎性因子 

分 类 号：R558.2[医药卫生—血液循环系统疾病]