补肾中药为主的中西医结合疗法治疗再生障碍性贫血的免疫学机制及疗效预测指

补肾中药为主的中西医结合疗法治疗再生障碍性贫血

的免疫学机制及疗效预测指标探讨

中国中医科学院西苑医院血液科 唐旭东 张姗姗 麻 柔 许勇钢 杨晓红 肖海燕 李 柳 胡乃平 郑春梅 刘 锋

摘要 目的 研究补肾中药为主的中西医结合疗法治疗再生障碍性贫血（以下简称再障）的免疫学机制，并寻找再碍疗效预测指标，以指导临床治疗。方法 研究主要观察应用以补肾中药为主的中西医结合疗法治疗后，再障患者外周血T细胞亚群和外周血象变化，观察总例数达85例。 结果 1.中西医结合再障治疗后肾阳虚型和肾阴虚型总有效率分别为97.2%和61.2%，AAA和CAA的总有效率分别为65.3%和91.7%；2. 中西医结合再障治疗后肾阳虚组和肾阴虚组外周血的白细胞、血红蛋白、血小板均显著上升（P<0.01），且肾阳虚组外周血象恢复明显优于肾阴虚组（P<0.01）；3.中西医结合再障治疗前肾阳虚和肾阴虚组患者CD3+（%）、CD3+CD8+（%）、CD45RO+（%）、CD4+CD45RO+（%）、CD8+CD45RO+（%）、Th1/Th2明显升高（P=0.001，P=0.001，P=0.002，P=0.035，P=0.001，P=0.046），CD3CD19（%）、CD3-CD16+C56+（%）、CD3+CD8+HLA-DR+明显降低（P=0.009，P=0.001，P=0.005），治疗后肾阳虚组免疫功能恢复明显优于肾阴虚组；4. 中西医结合再障治疗后肾阳虚和肾阴虚组的CD3CD8（%）、CD3HLA-DR（%）、CD8CD45RO（%）变化显著。结论 1. 再障患者免疫功能紊乱，T细胞亚群出现异常变化；2. 补肾中药为主的中西医结合治疗再障的方法疗效可靠，具有调节免疫功能作用，促进造血恢复 3.CD3CD8（%）、CD3HLA-DR（%）、CD8+CD45RO+（%）可能作为再障疗效评价的指标用于临床实践。 关键词 贫血，再生障碍性；免疫功能；补肾中药；疗效；预测指标

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Investigation on immunological mechanism and therapeutic prognosis indexes of aplastic anemia after intergrative medicine treatment wih Chinese herbs of invigorating the kidney TANG Xu-dong, ZHANG Shan-shan, MA Rou, XU Yong-gang, YANG Xiao-hong, XIAO Hai-yan, LI Liu, HU Nai-ping, ZHENG Chun-mei, LIU Feng. National Hematological Medical Center of Traditional Chinese Medicine. Department of Hematology, Xiyuan Hospital affiliated to China Academy of Traditional Chinese Medicine, Beijing 100091, P.R.China

Corresponding author: Ma Rou, Department of Hematology, Xiyuan Hospital affiliated to China Academy of Traditional Chinese Medicine, Beijing 100091, P.R.China E-mail: xyxysys@http://www.77cn.com.cn

Abstract Objective To evaluate the immunological mechanisms on aplastic anemia(AA) of intergrative medicine treeament with Chinese herbs of invigorating the kidney, and to try to find the prognosis indexes for therapeutics in order to guide the clinical practise. Methods Peripheral blood T cell sub-groups and T helper cells and peripheral blood are serially analyzed be flow cytometry before and after treatment of intergrative medicne treament. Results Firstly, the total effective rate of treatment of AA with intergrative medicine were 97.2% and 61.2% respectively in the group of deficiency of Kidney Yin and Kidney Yang, and 65.3% and 91.7% in the group of severe aplastic anemia(SAA) and mediate aplastic anemia(mAA). Secondly, after the treatment of 作者简介：唐旭东，男，主治医师，在读博士后，从事中西医结合血液学临床及科研研究。 作者单位：100091 北京，中国中医科学院西苑医院血液科 通讯作者：麻柔，男，博士后合作导师，以中西医结合血液学为主要研究方向。Email: xyxysys@http://www.77cn.com.cn 联系电话：010-62875627；传真：010-62874101

intergrative medicine treatment, the leucocyte, hemoglobin and platelet rose significantly in the group of deficiency of Kidney Yin and Kidney Yang (P<0.01).And convalescence of peripheral blood was better in the group of deficiency of Kidney Yin and Kidney Yang after the intergrative

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medicine treatment(P<0.01). Thirdly, CD3(%),CD3CD8(%),CD45RO(%),CD4CD45RO(%), CD8+CD45RO+(%) and Th1/Th2 were higher(P=0.001, P=0.001, P=0.002, P=0.035, P=0.001,

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P=0.046), CD3CD19(%), CD3CD16C56(%) and CD3CD8HLA-DR were lower (P=0.009，P=0.001，P=0.005) in the group of deficiency of Kidney Yin and Kidney Yang before the treatment. After the treatment, the immunological fuction in the group of deficiency of Kidney Yang had better restoration than that in the group of deficiency of Kidney Yin. Finally, after the treatment of intergrative medicine with Chinese herbs of invigorating the Kidney, CD3CD8(%),CD3HLA-DR(%) and CD8CD45RO(%) were different predominantly in he group of deficiency of Kidney Yin and Kidney Yang. Conclusion Firstly, there were functional disorder in patients of AA which had abnormal difference in T lymphocyte subgroup. Secondly, The intergrative medicine treatment with Chinese herbs of invigorating the kidney was reliable and safe, and had the function of immunological regulation to promote the renovation of hematopoiesis.Finally, CD3+CD8+(%),CD3+HLA-DR+(%) and CD8+CD45RO+(%) were different predominantly in he group of deficiency of Kidney Yin and Kidney Yang could be used as the prognosis indexes in the clinical practice. Key words anemia，aplastic；immunological function；Chinese herbs of invigorating the kidney; therapeutics; prognosis indexes

再生障碍性贫血（Aplastic Anemia，AA）主要表现为外周血全血细胞减少，是一组本质上以造血干/祖细胞损伤为特征的骨髓造血功能衰竭性疾病。目前认为AA最常见的发病机制是免疫介导的造血抑制。临床上大部分AA患者应用免疫抑制治疗（ …… 此处隐藏：13274字，全部文档内容请下载后查看。喜欢就下载吧 ……