养血活血方联合西药对血小板减少性紫癜患儿血清相关细胞因子、血小板参数及骨代谢的影响
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摘要
目的:探讨养血活血方联合西药对血小板减少性紫癜(ITP)患儿血清相关细胞因子、血小板参数及骨代谢的影响。方法:选取2015年6月至2017年1月永城市人民医院收治的ITP患儿103例作为研究对象,按照随机数字表法随机分为对照组(n=52)与观察组(n=51)。对照组采用醋酸泼尼松片及环孢素片治疗,观察组在对照组的基础上联合养血活血方治疗,2组均连续治疗3个月。比较治疗前后2组主要中医症状量化积分、血清细胞因子、血小板参数及骨代谢指标的变化。结果:治疗后观察组总有效率为94. 12%,显著高于对照组的76. 92%(P <0. 05);与治疗前比较,治疗后2组患儿中医症状量化积分均显著下降,且观察组明显低于对照组(均P <0. 01);与治疗前比较,治疗后2组血清IL-4、IL-6、INF-γ、TNF-α水平均显著下降,且观察组均明显低于对照组(均P <0. 01);与治疗前比较,治疗后2组PLT、PCT均显著升高,且观察组明显高于对照组(P <0. 05或P <0. 01),2组PDW、MPV均显著下降,且观察组明显低于对照组(P <0. 01);观察组治疗前后血清PⅠCP水平及尿DPD排泄率差异无统计学意义(P> 0. 05),而对照组血清PⅠCP浓度较治疗前显著降低,尿DPD排泄率较治疗前显著升高(均P <0. 01),且2组间差异有统计学意义(P <0. 01)。结论:在常规西药治疗的基础上联用养血活血方可有效缓解ITP患儿临床症状,降低血清细胞因子,改善血小板参数及骨代谢指标,促进患儿康复,提高临床疗效。
Objective: To explore the effevts of Yangxue Huoxue Recipe combined with western medicine on serum-related cytokines,platelet parameters and bone metabolism of children with idiopathic thrombocytopenia purpura( ITP). Methods: A total of103 cases of children with ITP in Yongcheng People's Hospital were selected and divided randomly into observation group( n = 51)and control group( n = 52). Control group was treated with prednisone acetate tablets and cyclosporine tablets,and observation group was treated with Yangxue Huoxue Recipe on the basis of control group. Both groups were treated for 3 months continuously.The clinical efficacy of the 2 groups was statistically analyzed. The TCM symptom quantification integral,serum cytokines,platelet parameters and bone metabolism indexes of 2 groups before and after treatment were compared. Results: After treatment,the total effective rate of observation group was 94. 12%,which was obviously higher than the 76. 92% of control group( P < 0. 05); Compared with before treatment,the TCM symptom quantification integral of 2 groups decreased significantly,and observation group was obviously lower than control group( P < 0. 01); Compared with before treatment,the serum IL-4,IL-6,INF-γ and TNF-α levels of2 groups decreased significantly after treatment,and observation group was obviously lower than control group( P < 0. 01); Compared with before treatment,the PLT,PCT of 2 groups increased significantly,and observation group was obviously higher than control group( P < 0. 05 or P < 0. 01). The PDW,MPV of 2 groups decreased significantly,and observation group was obviously lower than control group( P < 0. 01); There was no obvious difference in the levels of serum PⅠCP and urinary DPD in observation group before and after treatment( P > 0. 05). The serum PⅠCP concentration decreased significantly and the urinary DPD excretion rate increased significantly than before treatment of control group after treatment,and there was statically significant difference between 2 groups( P < 0. 01). Conclusion: Yangxue Huoxue Recipe combined with western medicine in the treatment of ITP can relieve effectively the TCM symptoms of ITP children,reduce the serum cytokines,improve the platelet parameters and bone metabolism,promote the rehabilitation of ITP children. Its clinical curative effect is remarkable.
Objective: To explore the effevts of Yangxue Huoxue Recipe combined with western medicine on serum-related cytokines,platelet parameters and bone metabolism of children with idiopathic thrombocytopenia purpura( ITP). Methods: A total of103 cases of children with ITP in Yongcheng People's Hospital were selected and divided randomly into observation group( n = 51)and control group( n = 52). Control group was treated with prednisone acetate tablets and cyclosporine tablets,and observation group was treated with Yangxue Huoxue Recipe on the basis of control group. Both groups were treated for 3 months continuously.The clinical efficacy of the 2 groups was statistically analyzed. The TCM symptom quantification integral,serum cytokines,platelet parameters and bone metabolism indexes of 2 groups before and after treatment were compared. Results: After treatment,the total effective rate of observation group was 94. 12%,which was obviously higher than the 76. 92% of control group( P < 0. 05); Compared with before treatment,the TCM symptom quantification integral of 2 groups decreased significantly,and observation group was obviously lower than control group( P < 0. 01); Compared with before treatment,the serum IL-4,IL-6,INF-γ and TNF-α levels of2 groups decreased significantly after treatment,and observation group was obviously lower than control group( P < 0. 01); Compared with before treatment,the PLT,PCT of 2 groups increased significantly,and observation group was obviously higher than control group( P < 0. 05 or P < 0. 01). The PDW,MPV of 2 groups decreased significantly,and observation group was obviously lower than control group( P < 0. 01); There was no obvious difference in the levels of serum PⅠCP and urinary DPD in observation group before and after treatment( P > 0. 05). The serum PⅠCP concentration decreased significantly and the urinary DPD excretion rate increased significantly than before treatment of control group after treatment,and there was statically significant difference between 2 groups( P < 0. 01). Conclusion: Yangxue Huoxue Recipe combined with western medicine in the treatment of ITP can relieve effectively the TCM symptoms of ITP children,reduce the serum cytokines,improve the platelet parameters and bone metabolism,promote the rehabilitation of ITP children. Its clinical curative effect is remarkable.
引文
[1]温玉玲,金福厚,杜萍.儿童血小板减少性紫癜的中医治疗[J].中国现代药物应用,2015,9(4):209-210.
[2]张玉荣.慢性特发性血小板减少性紫癜采用养阴清热、凉血止血法联合西药治疗的临床效果分析[J].中国医药导刊,2016,18(2):170-172.
[3]顾小海,刘宏伟.糖皮质激素联合丙球蛋白治疗特发性血小板减少性紫癜患儿的临床研究[J].中国临床药理学杂志,2016,32(3):218-220.
[4]黄梅,李林,张晓芬,等.仙丹升血颗粒治疗特发性血小板减少性紫癜的疗效观察[J].世界中医药,2014,9(10):1307-1309.
[5]代喜平.凉血清热升板方配合糖皮质激素治疗血热型ITP及ITP调节性T细胞研究[D].广州:广州中医药大学,2014:8-11.
[6]张之南.血液病诊断及疗效标准[S].2版.北京:科学出版社,1998:145-147.
[7]国家食品药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:263-265.
[8]常冬梅.特发性血小板减少性紫癜中医证候分布规律探讨[D].郑州:河南中医学院,2012:6-9.
[9]苏懿,马明远.当代医家中医药治疗特发性血小板减少性紫癜的规律探讨[J].北方药学,2016,13(6):148-150.
[10]宋明福,王安桥,朱国龙,等.“生血二号”治疗特发性血小板减少性紫癜对巨核细胞影响的实验研究[J].世界中医药,2012,7(2):164-165.
[11]张丽娜.益气养血法治疗老年特发性血小板减少性紫癜30例临床观察[J].河北中医,2012,34(1):31-32.
[12]李克煦.清热凉血法治疗特发性血小板减少性紫癜[J].四川中医,2005,23(3):61.
[13]阮毅燕,陈瑜毅,唐文珏,等.特发性血小板减少性紫癜患儿细胞免疫功能变化及临床意义[J].医学研究杂志,2017,46(2):43-45.
[14]刘夫红.Th1/Th2及Th17/Treg细胞平衡在免疫性血小板减少症发病中的意义[J].中国小儿血液与肿瘤杂志,2013,18(2):90-92.
[15]刘宗堂,马骥,贺伟东,等.免疫性血小板减少症Th1和Th2趋化因子及其受体表达的研究[J].免疫学杂志,2014,11(8):717-721.
[16]U9ar C,ren,Hale,I˙Rken G,et al.Investigation of megakaryocyte apoptosis in children with acute and chronic idiopathic thrombocytopenic purpura[J].European Journal of Haematology,2015,70(6):347-352.
[17]陆泳萍.养血和血方治疗免疫性血小板减少性紫癜的疗效研究及对细胞因子、血小板参数的影响[J].河北中医药学报,2016,31(1):48-51.
[18]何昊,孙艳平,郑蕾,等.健脾益气摄血方对ITP模型小鼠外周血象的影响[J].中医药学报,2015,43(6):22-24.
[19]Brabnikova M K,Pavelka K,Stepan J J.Acute effects of glucocorticoids on serum markers of osteoclasts,osteoblasts,and osteocytes[J].Calcified Tissue International,2013,92(4):354-354.
[20]李彦格,李慧霞,刘炜,等.糖皮质激素对急性ITP患儿骨密度和成骨细胞功能影响及维生素D干预研究[J].中国实用医刊,2012,39(20):53-55.
[2]张玉荣.慢性特发性血小板减少性紫癜采用养阴清热、凉血止血法联合西药治疗的临床效果分析[J].中国医药导刊,2016,18(2):170-172.
[3]顾小海,刘宏伟.糖皮质激素联合丙球蛋白治疗特发性血小板减少性紫癜患儿的临床研究[J].中国临床药理学杂志,2016,32(3):218-220.
[4]黄梅,李林,张晓芬,等.仙丹升血颗粒治疗特发性血小板减少性紫癜的疗效观察[J].世界中医药,2014,9(10):1307-1309.
[5]代喜平.凉血清热升板方配合糖皮质激素治疗血热型ITP及ITP调节性T细胞研究[D].广州:广州中医药大学,2014:8-11.
[6]张之南.血液病诊断及疗效标准[S].2版.北京:科学出版社,1998:145-147.
[7]国家食品药品监督管理局.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002:263-265.
[8]常冬梅.特发性血小板减少性紫癜中医证候分布规律探讨[D].郑州:河南中医学院,2012:6-9.
[9]苏懿,马明远.当代医家中医药治疗特发性血小板减少性紫癜的规律探讨[J].北方药学,2016,13(6):148-150.
[10]宋明福,王安桥,朱国龙,等.“生血二号”治疗特发性血小板减少性紫癜对巨核细胞影响的实验研究[J].世界中医药,2012,7(2):164-165.
[11]张丽娜.益气养血法治疗老年特发性血小板减少性紫癜30例临床观察[J].河北中医,2012,34(1):31-32.
[12]李克煦.清热凉血法治疗特发性血小板减少性紫癜[J].四川中医,2005,23(3):61.
[13]阮毅燕,陈瑜毅,唐文珏,等.特发性血小板减少性紫癜患儿细胞免疫功能变化及临床意义[J].医学研究杂志,2017,46(2):43-45.
[14]刘夫红.Th1/Th2及Th17/Treg细胞平衡在免疫性血小板减少症发病中的意义[J].中国小儿血液与肿瘤杂志,2013,18(2):90-92.
[15]刘宗堂,马骥,贺伟东,等.免疫性血小板减少症Th1和Th2趋化因子及其受体表达的研究[J].免疫学杂志,2014,11(8):717-721.
[16]U9ar C,ren,Hale,I˙Rken G,et al.Investigation of megakaryocyte apoptosis in children with acute and chronic idiopathic thrombocytopenic purpura[J].European Journal of Haematology,2015,70(6):347-352.
[17]陆泳萍.养血和血方治疗免疫性血小板减少性紫癜的疗效研究及对细胞因子、血小板参数的影响[J].河北中医药学报,2016,31(1):48-51.
[18]何昊,孙艳平,郑蕾,等.健脾益气摄血方对ITP模型小鼠外周血象的影响[J].中医药学报,2015,43(6):22-24.
[19]Brabnikova M K,Pavelka K,Stepan J J.Acute effects of glucocorticoids on serum markers of osteoclasts,osteoblasts,and osteocytes[J].Calcified Tissue International,2013,92(4):354-354.
[20]李彦格,李慧霞,刘炜,等.糖皮质激素对急性ITP患儿骨密度和成骨细胞功能影响及维生素D干预研究[J].中国实用医刊,2012,39(20):53-55.