滋阴和阳方治疗激素依赖原发免疫性血小板减少症临床研究  

Clinical research of Ziyin-Heyang Decoction on the treatment of glucocorticoid-dependent primary immune thrombocytopenia

作　　者：季菲[1] 贺晓芳[1] 胡晓梅[2] 许勇钢[2] 邓力军[1] Ji Fei;He Xiaofang;Hu Xiaomei;Xu Yonggang;Deng Lijun(Department of Internal Medicine,South Area of Gulou Hospital of Traditional Chinese Medicine of Beijing,Beijing 100075,China;Department of Hematology,Xiyuan Hospital of China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]北京市鼓楼中医医院(南院区)内科,100075 [2]中国中医科学院西苑医院血液科,北京100091

出　　处：《国际中医中药杂志》2020年第11期1058-1063,共6页International Journal of Traditional Chinese Medicine

基　　金：北京市东城区优秀人才培养资助项目(2014074181449G012);国家重点基础研究发展计划(973计划)项目(2015CB554403)。

摘　　要：目的观察滋阴和阳方治疗激素依赖原发免疫性血小板减少症(primary immune thrombocytopenia, ITP)的疗效。方法将符合入选标准的中国中医科学院西苑医院2015年11月-2017年11月ITP患者70例,采用随机数字表法分为2组。对照组口服标准剂量醋酸泼尼松,根据PLT水平逐步撤减激素;治疗组在对照组基础上加用滋阴和阳方。2组均8周为1个疗程,共治疗2个疗程。除剔除的5例外,治疗组33例、对照组32例完成本研究。2组患者分别于治疗前后进行中医证候评分,采用电阻抗法检测PLT,计算出血评分,记录每日服用醋酸泼尼松片剂量,采用流式细胞术检测血小板相关抗体(PAIgA、PAIgG、PAIgM、PAIgD),评价临床疗效及证候疗效。结果治疗组临床总有效率为75.8%(25/33)、对照组为53.1%(17/32),2组比较差异有统计学意义(Z=2.846,P<0.05);治疗组中医证候疗效总有效率为100.0%(33/33)、对照组为75.0%(24/32),2组比较差异有统计学意义(Z=3.841,P<0.05)。治疗后,治疗组PLT[(97.6±39.9)×10^9/L比(70.9±16.6)×10^9/L,t=3.540]高于对照组(P<0.05),中医证候积分[6.00(4.00)分比10.00(6.00)分,Z=3.510]低于对照组(P<0.05)。治疗结束时,治疗组醋酸泼尼松片用量[5.00(17.50)mg/d比27.66(11.98)mg/d,Z=4.186]低于对照组(P<0.05)。2组出血评分均下降,但组间比较未见明显差异(P>0.05)。治疗组血小板相关抗体水平治疗前后比较,差异无统计学意义(P>0.05)。结论滋阴和阳方治疗激素依赖ITP在提升PLT、撤减激素、改善症状方面具有优势。Objective To observe the clinical efficacy of Ziyin-Heyang Decoction on the treatment of glucocorticoid-dependent primary immune thrombocytopenia.Methods A total of 70 patients with ITP in Xiyuan Hospital of China Academy of Chinese Medical Sciences from November 2015 to November 2017 who met the inclusion criteria were divided into two groups according to the random number table method.33 cases in the treatment group and 32 cases in the control group completed the reaserch.The control group received standard dose of prednisone acetate orally,and the dose was gradually reduced according to platelet count;and the treatment group was given Ziyin-Heyang Decoction on the basis of the control group.Both groups had one course of treatment for 8 weeks,with a total of 2 courses of treatment.Before and after treatment,TCM syndrome score was performed,PLT was detected by impedance method,bleeding score was calculated,daily dosage of prednisone acetate tablets was recorded,and platelet related antibodies(PAIgA,PAIgG,PAIgM,PAIgD)were detected by flow cytometry.Then clinical and syndrome efficacy were evaluated.Results The total effective rate was 75.8%(25/33)in the treatment group and 53.1%(17/32)in the control group,and the difference in efficacy was statistically significant(Z=2.846,P<0.05).For the TCM syndromes,the total effective rate was 100.0%(33/33)in the treatment group and 75.0%(24/32)in the control group,and there was a statistical difference between them(Z=3.841,P<0.05).After treatment,the platelet count improvement[(97.6±39.9)×10^9/L vs.(70.9±16.6)×10^9/L,t=3.540]of the treatment group was significantly higher than that of the control group(P<0.05).The TCM syndrome score[6.00(4.00)vs.10.00(6.00),Z=3.510]of the treatment group was significantly lower than that of the control group(P<0.05).After the treatment,the dose of prednisone acetate tablets[5.00(17.50)mg/d vs.27.66(11.98)mg/d,Z=4.186]of the treatment group was significantly lower than that of the control group(P<0.05).Bleeding score decreased in both gro

关 键 词：血小板减少 免疫 激素依赖性 滋阴和阳方 中医药疗法 

分 类 号：R259[医药卫生—中西医结合]