凉血止血理肝扶脾法治疗特发性血小板减少性紫癜的临床研究

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1、提要目的：观察凉血止血、理肝扶脾法对特发性血小板减少性紫癜（IdiopathicThromboeytopenicPurpura，ITP)患者的临床疗效及对血清IL-6、骨髓TGF-ß1的影响，初步探讨该治法的作用机制。方法：将72例ITP患者随机分为治疗组和对照组，治疗组37例，给予凉血止血、理肝扶脾中药；对照组35例，给予升血小板胶囊。疗程均为12周，观察治疗前后两组患者外周血象、血清IL-6、骨髓TGF-ß1变化及证候学积分改变。结果：治疗组总有效率88.9%，对照组总有效率79.4%，两组疗效有显著差异（P<0.05）；治疗组与对照组患者血小板计数均升高，与治疗前比较有明显差异(P<

2、0.05)，且治疗组复发型患者血小板计数较同型对照组患者升高明显(P<0.05)；两组患者治疗后骨髓颗粒型、裸核型巨核细胞数均降低，产板型巨核细胞升高，与治疗前比较差异显著(P<0.05)，且复发型患者产板型巨核细胞升高优于对照组(P<0.05)；两组患者血清IL-6水平均有不同程度下降(P<0.05)，且治疗组复发型患者较对照组下降显著(P<0.05)；两组患者骨髓TGF-ß1均降低(P<0.05)，治疗组复发型患者较对照组减降低更为显著(P<0.05)。结论：凉血止血、理肝扶脾法治疗ITP疗效肯定，能明显改善患者中医证侯及出血症状，降低血清IL-6及骨髓TGF-ß1水平，增加骨髓产板型

3、巨核细胞及外周血小板数量，对复发型患者疗效优于升血小板胶囊，其具体作用机理有待于进一步探讨。关键词临床研究；特发性血小板减少性紫癜；凉血止血、理肝扶脾法ClinicalResearchonTreatingITPwiththeTherapyofHarmonizingLoverandAssistingSpleenandChillingBloodSPeciality：InternalMedieineoflntegratedTCMandWesternMedicine.Author：DuZhonghai..Tutor：ProfessorSunChanggang.AbstractObjective:T

4、oobservethecurativeeffectandchangesofIL-6andTGF-ß1onthepatientswithidiopathicthrombocytopenicpurpura（ITP）whichtreatedwiththerapyofharmonizingloverandassistingspleenandchillingblood,andunveilitsmechanismofantagonizingITP.Methods:72patientsofITPweredividedintotreatmentgroup(37cases)andcontrolgroup(3

5、5cases)randomly,treatedwithchinesetraditionalmedicineandShengxue-xiaobancapsulerespetively.After12weeks,observeandnotethechangesofsymptomssumandIL-6inserum,TGF-ß1inbonemarrow.Results:Thetotalefficiencyintreatmentgroupwas88.9%,and79.4%incontrolgroup,therehadsignificantdifferencebetweenthem(P<0.05);

6、Theplateletcountwasincreasedinbothgroups,andhadobviouscontrastagainstthepre-treatment(P<0.05),andtheplateletcountofrecrudescenttypeintreatmentgroupwassignificandeviationcomparedtothecontrolgroup(P<0.05);Thecountofbonemarrowgranularmegakaryocyteandmegakaryocytesbarekaryotypewasdecreasedboth,andprod

7、uctiontypeofmegakaryocytewasincreasedbothaftertreatment,andthepost-treatmentgroupissuperiortothatofpre-treatment(P<0.05).Inaddition,theproductiontypeofmegakaryocyteintreatmentgroupissuperiortothatofcontrolgroup(P