“补肾活血”法治疗慢性再生障碍性贫血患者输血相关性铁负荷过载的效果分析  

Efficacy of“Bushen Huoxue”therapy in patients with transfusion related iron overload in chronic aplastic anemia

作　　者：仇如意 叶宝东[2] 侯佳慧 姚轶敏 李强 俞颖[1] QIU Ruyi;HU Jiahui;YAO Yimin;LI Qiang;YU Ying(Department of Laboratory,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学附属第一医院检验科,浙江杭州310006 [2]浙江中医药大学附属第一医院血液科,浙江杭州310006

出　　处：《中国输血杂志》2021年第7期720-724,共5页Chinese Journal of Blood Transfusion

基　　金：国家中医药管理局省部共建项目(JDZX2015118);浙江省自然科学基金(LQ21H08001)。

摘　　要：目的探讨中医疗法治疗慢性再生障碍性贫血(CAA)患者输血相关性铁负荷过载的临床疗效。方法纳入本院血液科2015年2月~2016年12月的CAA合并铁过载115例,根据事前设计治疗方案不同,分为"补肾活血"法干预组(n=69,简称观察组):在西医基础治疗前提下采用中药"补肾活血"祛铁法,即黄芪40 g、熟地12 g、萸肉12 g、鹿角胶烊化12 g、白术20 g、白芍20 g、仙茅10 g、仙灵脾10 g、肉苁蓉12 g、桂枝10 g、陈皮8 g、茯苓10 g、生姜6 g、当归20 g、丹参20 g、片姜黄9 g、益母草30 g、紫草15 g、炙甘草6 g,每日1剂;阳性对照组(n=16):采用西药去铁胺(20~40)mg·kg^(-1)·d^(-1),持续给药时间>8 h/d,(5~7)d/周;阴性对照组(n=30):仅接受西医基础治疗。3组患者均采用中医血瘀证候评分,检测患者治疗前及治疗3个月后的血清铁蛋白(SF)、细胞因子等水平,并对治疗后铁蛋白下降水平与血瘀证评分改善情况做相关性分析。结果观察组、阳性及阴性对照组3组患者SF(μg/L):治疗前分别为1881.63±1386.81、6581.36±5180.96以及1974.25±1753.06,治疗3个月后分别为2040.14±1484.27 vs 4169.18±3631.64(P<0.05)vs 2699.80±2352.34(P<0.05),观察组治疗应答率达23.19%(16/69);血瘀证候积分(分):治疗前分别为4.26±1.45、6.88±1.31、4.17±1.18,治疗3个月后分别为分别为4.42±1.43 vs 5.00±0.89 vs 4.67±1.51(P<0.01),观察组血瘀证积分改善有效率达26.09%;SF水平与血瘀证评分改善情况呈负相关(P<0.01);在观察组中细胞因子、IL-6、IL-10(pg/mL):治疗前分别为20.79±14.14、56.27±25.54,治疗3个月后分别为13.00±6.48、41.02±9.93(P<0.05)。结论"补肾活血"法治疗CAA合并输血相关性铁负荷过载,可有效稳定患者SF,改善其"血瘀证"症状。Objective To explore the clinical efficacy of traditional Chinese medicine(TCM)therapy in patients with transfusion related iron overload diagnosed with chronic aplastic anemia(CAA).Methods A total of 115 patients with CAA and iron overload who had been admitted to Zhejiang Provincal Hospital of TCM from February 2015 to December 2016 were studied.They were assigned to treatment group(n=69),positive control group(n=16),and negative control group(n=30)according to different treatment plan designed in advance.Patients in the treatment group were treated with TCM of“Bushen Huoxue”recipe once a day,with the formula mixed with astragalus 40 g,rehmannia 12 g,cornus 12 g,deerhorn glue melting by heat 12 g,atractylodes 20 g,radix paeoniae alba 20 g,curculigo orchioides 10 g,herba epimedii 10 g,cistanche 12 g,cassia stem 10 g,dried orange peel 8 g,poria 10,gingembre 6 g,angelica sinensis 20 g,salvia miltiorrhiza 20 g,zedoary 9 g,leonurus 30 g,gromwell 15 g,and prepared liquorice root 6 g.Patients in positive control group were treated with desferrioxamine for more than 8 h per day,5 to 7 days per week.Patients in negative control group were treated with basic treatment.The serum ferritin(SF)and cytokines of patients of the three groups before and 3 months after therapy were detected according to the blood-stasis of TCM symptom rating scale,and the correlation between the decrease of ferritin after treatment and the improvement of blood stasis syndrome score was analyzed.Results The level of SF of the treatment group,positive and negative control group before treatment were 1881.63±1386.81 vs 6581.36±5180.96 vs1974.25±1753.06,and were 2040.14±1484.27 vs 4169.18±3631.64(P<0.05)vs 2699.80±2352.34(P<0.05)3 months after treatment.The treatment was effctive in 16 patients in treatment group,accounted for 23.19%(16/69).The score of blood stasis syndrome of the three groups before and after treatment were 4.26±1.45vs 6.88±1.31 vs 4.17±1.18 and 4.42±1.43 vs 5.00±0.89 vs 4.67±1.51(P<0.01),respectively.The effective

关 键 词：再生障碍性贫血 慢性 铁过载 输血 “补肾活血”法 血瘀症 

分 类 号：R243[医药卫生—中医临床基础]