复方参鹿颗粒干预肾阳虚型骨髓增生异常综合征造血调控的临床观察

Clinical observation on haematogenesis of complex Shenlu grannie in treating deficiency myelodysplastic syndrome due to kidney yang

目的评判复方参鹿颗粒对肾阳虚型骨髓增生异常综合征（MDS）（难治性贫血／难治性血细胞减少伴多系造血异常）（RA／RCMD）造血调控情况。方法30例MDS—RA／RCMD患者随机分成复方参鹿颗粒组（简称参鹿组）（15例）和十一酸睾酮组（15例），测评治疗前后外周血象、T细胞亚群＋自然杀伤（NK）细胞、骨髓细胞免疫表型。结果参鹿组与治疗前相比，红细胞、血色素、血小板有明显上升，治疗前分别为（2．39±0．99）×10^12／L、（84．47±28．68）g／L、（81．13±96．85）×10^9／L，治疗后分别为（2．80±0．98）×10^12／L、（94．87±25．63）g／L、（98．67±107．9）×10^9／L，差异均有统计学意义（t=4．0359、t=2．7009、t=2．2573，均P〈0．05），十一酸睾酮组仅有血红蛋白数量上升，治疗前为（71．93±27．53）g／L，治疗后为（80．07±26．03）g／L，差异有统计学意义（t=2．3125，P=0．0365）；参鹿组治疗后CD4^＋、CD8^＋、CD4^＋／CD8^＋、NK细胞均达到或接近正常值，分别为（37．9±5．9）％、（24．0±5．8）％、1．75±0．83、（13．0±6．9）％，与治疗前的（29.3±11．7）％、（29．6±5．8）％、1．12±0．59、（8．8±5．7）％相比差异有统计学意义（t=2．6194、t=2．6595、t=2．6581、t=2．2288，均P〈0．05），十一酸睾酮组治疗后仅CD8^＋、CD4^＋／CD8^＋接近正常值，分别为（22．1±7．5）％、1．50±0．74，与治疗前（26．6±7．5）％、1．18±0．55相比差异有统计学意义（t=2．2377，P=0．0420；t=2．9352，P=0．0109），治疗后，参鹿组CD4^＋表达率为（37．9±5．9）％，十一酸睾酮组为（30．5±12．6）％，差异有统计学意义（t=2．1738，P=0．0474）；参鹿组对骨髓细胞CD13^＋、CD33^＋、CD34^＋、CD64^＋、CD117^＋，的异常阳性表达调控能力强于安雄组（前三者u=2．76、u=3．39、u=2．85，均P〈0．01，后两者u=2．17、u=2．46，均P〈0．05）。结论复方参鹿颗粒能有效调控肾阳虚型MDS—RA／RCMD正常造血功能。

Objective To evaluate haematogenesis of complex Shenlu granule in treating myelodysplastic syndrome （RA/RCMD） due to kidney yang deficiency. Methods The qualified cases were randomly divided into the complex Shenlu granule group and the Andriol group. During treatment, indexes such as peripheral hemogram, T cell subgroup, NK cell and immunological phenotypic expression of BMC were tested. Results Compared with prior treatment, Rbc, Hb and Plt have significantly increased in Shenlu group [prior treatment： （2.39±0.99）×10^12/L, （84.47±28.68） g/L, （81.13±96.85）×10^9/L; post-treatment （2.80±0.98）×10^12/L, （94.87±25.63） g/L, （98.67±107.9）×10^9/L, and the difference was statistically significant （t =4.0359, P =0.001, t =2.7009, P =0.0172, t =2.2573, P = 0.0405）. Andriol group has only increased Hb [prior treatment： （71.93±27.53） g/L; post-treatment （80.07±26.03） g/L] was statistically significant （t =2.3125, P =0.0365）. After treatment, CD4^＋, CD8^＋, CD4^＋/CD8^＋, and NK were at or near normal value in Shenlu group （37.9± 5.9） %, （24.0±5.8） %, 1.75±0.83, （13.0±6.9） %, compared with prior treatment （29.3±11.7） %, （29.6±5.8） %, 1.12±0.59, （8.8±5.7） %. The difference was statistically significant （t =2.6194, P =0.0202, t = 2.6595, P =0.0187, t =2.6581, P =0.0187, t =2.2288, P =0.0427, P 〈0.05）, and CD8^＋, CD4^＋/CD8^＋ close to normal in Andriol group [（22.1±7.5） %, 1.50±0.74], prior treatment [（26.6±7.5） %, 1.18±0.55]. The difference was statistically significant （t =2.2377, P =0.0420, t =2.9352, P =0.0109, P 〈0.05）. After treatment, CD4^＋ [Shenlu group： （37.9±5.9） %, Andriol group： （30.5±12.6） %] difference was statistically significant （t =2.1738, P =0.0474） in two groups; Shenlu group control abnormal expression of bone marrow cells, which were CD13^＋, CD33^＋, CD34^＋, CD64^＋,CD117^＋. The effect was better than Andriol group （the first three： u =2.76, u =3.39, u =2.85, P 〈0.01, the latter two： u =2.17, u =2.46, P 〈0.05）. Conclusion elomplex Shenlu granule can effectively control normal hematopoietie function for MDS （RA/RCMD） due to kidney Yang deficiency.