芪黄汤治疗免疫性血小板减少症的疗效及对细胞相关因子和外周血T淋巴细胞程序性死亡受体-1/程序性死亡配体-1的影响  

Curative effect of Qihuang Decoction on immune thrombocytopenia and its influence on cell-related factors and peripheral blood lymphocytes programmed death 1/programmed death ligand-1

作　　者：周林[1] 戴燚[2] 刘毓玲[1] ZHOU Lin;DAI Yi;LIU Yuling(Department of Laboratory Medicine,Wuhan Hospital of Traditional Chinese Medicine,Hubei,Wuhan 430050;Comprehensive Ward,Wuhan Hospital of Traditional Chinese Medicine,Hubei,Wuhan 430050)

机构地区：[1]湖北省武汉市中医医院检验科,湖北武汉430050 [2]湖北省武汉市中医医院综合病区,湖北武汉430050

出　　处：《河北中医》2023年第9期1449-1453,1458,共6页Hebei Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局全国中医药创新骨干人才培训项目(国中医药人教函[2019]128号);湖北省自然科学基金项目(编号:2017CFB485);武汉市卫生健康委员会医学科研项目(编号:WZ21M02)。

摘　　要：目的 观察芪黄汤治疗免疫性血小板减少症(ITP)的疗效及对细胞相关因子和外周T血淋巴细胞程序性死亡受体-1(PD-1)/程序性死亡配体-1(PD-L1)的影响。方法 将90例ITP患者按照随机数字表法分为2组,对照组45例予糖皮质激素治疗,治疗组45例在对照组治疗基础上加芪黄汤治疗,2组均治疗2个月。比较2组疗效;观察2组治疗前后ITP出血评分;比较2组治疗前后血小板(PLT)计数、血小板相关抗体(PAIg)G、PAIgM;比较2组治疗前后干扰素γ(IFN-γ)、白细胞介素10(IL-10)、转化生长因子-β(TGF-β)、IL-17水平变化;比较2组治疗前后外周血T淋巴细胞PD-1/PD-L1水平变化。结果 治疗组总有效率86.67%(39/45),复发率10.26%(4/39);对照组总有效率68.89%(31/45),复发率29.03%(9/31)。治疗组疗效优于对照组(P<0.05),复发率低于对照组(P<0.05)。2组治疗后ITP出血评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05)。2组治疗后PLT计数较治疗前升高(P<0.05),PAIgG、PAIgM均较本组治疗前降低(P<0.05);治疗后治疗组PLT计数高于对照组(P<0.05),PAIgG、PAIgM均低于对照组(P<0.05)。2组治疗后IFN-γ、IL-17水平均较本组治疗前降低(P<0.05),IL-10、TGF-β水平较本组治疗前升高(P<0.05);治疗后治疗组IFN-γ、IL-17水平均低于对照组(P<0.05),IL-10、TGF-β水平均高于对照组(P<0.05)。2组治疗后外周血CD4^(+)PD-1^(+)、CD8^(+)PD-1^(+)、CD4^(+)PD-L1^(+)、CD8^(+)PD-L1^(+)水平均较本组治疗前降低(P<0.05);治疗后治疗组外周血CD4^(+)PD-1^(+)、CD4^(+)PD-L1^(+)水平均低于对照组(P<0.05)。结论 糖皮质激素治疗基础上加芪黄汤治疗ITP,可提高临床疗效,可能与通过调节细胞因子和CD4^(+)T淋巴细胞PD-1/PD-L1信号表达水平进而改善免疫平衡相关。Objective To observe the curative effect of Qihuang Decoction on immune thrombocytopenia(ITP)and its influence on cell-related factors and peripheral blood lymphocytes(PBLs)programmed death 1(PD-1)/programmed death ligand-1(PD-L1).Methods A total of 90 ITP patients were randomly assigned into the treatment group(n=45)and the control group(n=45).All patients were managed by glucocorticoid,and those in the treatment group were additionally treated with Qihuang Decoction.Treated for 2 months,the key observation was ITP bleeding score,platelet(PLT)count,platelet-associated immunoglobulin G(PAIgG),PAIgM,interferon gamma(IFN-γ),interleukin-10(IL-10),transforming growth factor-β(TGF-β),IL-17,PD-1/PD-L1.The curative effect was assessed.Results The overall effective rate in the treatment group was better than that in the control group(86.67%[39/45]vs 68.89%[31/45],P<0.05).The recurrence rate in observation group was lower than that in control group(10.26%[4/39]vs 29.03%(9/31),P<0.05).After treatment,ITP bleeding score in the two groups was decreased(P<0.05),the treatment group was more common(P<0.05).Elevated PLT count and reduced PAIgG and PAIgM were found in the two groups than those before treatment(all P<0.05),and the different was significant in PLT count,and PAIgG and PAIgM between groups(all P<0.05).Decreased IFN-γand IL-17,and increased IL-10 and TGF-βwere detected in the two groups(all P<0.05),and the treatment group was superior to the control group for IFN-γ,IL-17,IL-10,TGF-β(all P<0.05).CD4+PD-1+,CD8+PD-1+,CD4+PD-L1+,CD8+PD-L1+in the two groups were decreased(P<0.05),CD4+PD-1+and CD4+PD-L1+in the treatment group were decreased than those in the control group(P<0.05).Conclusion For ITP patients,glucocorticoid combined with Qihuang Decoction can improve immune balance by regulating cytokines and expression of peripheral blood CD4+T cell PD-1/PD-L1,thereby improving clinical efficacy.

关 键 词：血小板减少 中药疗法 

分 类 号：R558.2[医药卫生—血液循环系统疾病] R289.6[医药卫生—内科学]