补肾化痰活血法联合ATG治疗重型再生障碍性贫血临床研究  

Study on Clinical Effect of Kidney-tonifying and Phlegm-eliminating and Blood-activating Method Combined with ATG in Treatment of Severe Aplastic Anemia

作　　者：张伟锋[1] 高宏[1] 杨向东[1] 杨文华[1] 史哲新[1] ZHANG Weifeng;GAO Hong;YANG Xiangdong;YANG Wenhua;SHI Zhexin(First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院,天津300381

出　　处：《辽宁中医杂志》2021年第6期150-153,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局中医药行业专项(201507001-13);天津市卫生和计划生育委员会中医、中西医结合科研专项课题(2015094);天津中医药大学第一附属医院“拓新工程”项目(院201414)。

摘　　要：目的探讨补肾化痰活血法联合抗胸腺细胞球蛋白(ATG)治疗重型再生障碍性贫血(SAA)的临床疗效。方法选取该院血液科2016年1月—2018年1月期间住院的重型再障患者30例,随机分为两组:对照组给予ATG联合环孢菌素A、治疗组在对照组的基础上联合补肾化痰活血法中药复方,分别观察两组患者的临床疗效、中医证候疗效、比较两组的骨髓增生程度、血常规相关指标、T淋巴细胞亚群、肝肾功能情况、及生存和复发情况。结果 ①疗效比较:治疗组总有效率为88.67%(13/15),显著高于对照组的73.33%(11/15)(P<0.05);治疗组中医证候积分总有效率为93.33%(14/15),显著高于对照组的80%(12/15)(P<0.05);治疗后两组的骨髓增生程度、WBC、ANC、HGB、PLT、Ret%均明显改善,治疗组WBC、ANC、HGB、Ret%水平均显著高于对照组(P<0.05),PLT水平与对照组相当(P>0.05),治疗组CD4^(+)、CD4^(+)/CD8^(+)水平均明显高于对照组,而CD8^(+)显著低于对照组(P<0.05)。②肝肾功能异常率及1年生存/复发率比较:治疗组的肝肾功能异常发生率为53.33%(8/15),显著高于对照组的33.33%(5/15)(P<0.05);治疗组的1年生存率(93.33%,14/15)/复发率(6.67%,1/15)显著优于对照组的生存率(86.67%,13/15)/复发率(20.0%,3/15)。结论补肾化痰活血法联合ATG治疗重型再生障碍性贫血疗效显著,可改善患者骨髓造血,提高生存率,降低复发率和肝肾功能损伤,使患者获益,具有推广价值。Objective To investigate the clinical effect of kidney-tonifying and phlegm-eliminating and blood-activating method combined with ATG in the treatment of severe aplastic anemia.Methods Thirty patients with severe aplastic anemia were randomly divided into control and observation groups in our hospital from January 2016 to January 2018.The control group was treated with ATG and cyclosporin.The treatment group was given kidney-tonifying and phlegm-eliminating and blood-activating method besides the above treatment.The clinical efficacy and TCM symptoms curative effect of two groups were observed.The degree of bone marrow hyperplasia,blood routine,T lymphocyte subsets,hepatorenalfunction and the rate of recurrence and survival were compared.Results①The curative effect of the treatment group(88.67%,13/15) was obvious better than that of the control group(73.33%,11/15)(P<0.05).TCM symptoms curative effect of the treatment group(93.33%,14/15) was obvious better than that of control group(80.00%,12/15)(P<0.05).The degree of bone marrow hyperplasia,WBC,ANC,HGB,PLT and Ret% were raised in the two groups after treatment.WBC,ANC,HGB and Ret% in the treatment group were higher than those in the control group(P<0.05).PLT number was similar(P>0.05).Compared with those of the control group,CD4^(+) and the ratio of CD4^(+)/CD8^(+) were raised obviously(P<0.05).CD8^(+) was reduced obviously(P<0.05).②Abnormal liver and kidney function rate of the treatment group(53.33%,8/15) was obvious better than that of the control group(33.33%,5/15).The 1-year survival/recurrence rates of the treatment group(93.33%,14/15,6.67%,1/15) were obvious better than those of the control group(86.67%,13/15,20.0%,3/15).Conclusion The kidney-tonifyingand phlegm-eliminating and blood-activating method combined with ATG was effective in severe aplastic anemia,can improve the patients′ bone marrow hematopoiesis and the survival rate and reduce the recurrence rate and liver and kidney damage,bringing benefit to the patients.

关 键 词：重型再生障碍性贫血 ATG 补肾活血化痰法 

分 类 号：R556[医药卫生—血液循环系统疾病]