基于HIF-1α/NF-κB通路探究三黄三仙汤联合常规西药治疗非重型再生障碍性贫血临床效果

Clinical Efficacy of Sanhuang Sanxian Decoction Combined with Conventional Western Medicine in the Treatment of Non-severe Aplastic Anemia Based on HIF-1α/NF-κB Pathway

目的基于缺氧诱导因子-1α(HIF-1α)/核因子-κB(NF-κB)通路探究三黄三仙汤联合常规西药治疗非重型再生障碍性贫血临床效果。方法选取2017年5月—2022年2月收治的非重型再生障碍性贫血92例,依据治疗方案不同分为观察组和对照组2组各46例。观察组采用三黄三仙汤联合常规西药治疗,对照组仅采用常规西药治疗。比较2组治疗6个月后临床效果,治疗前和治疗3、6个月后中医证候积分、血常规及HIF-1α/NF-κB通路相关mRNA、细胞因子[肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)],以及治疗期间不良反应发生情况。结果治疗6个月后,总有效率观察组为84.78%高于对照组60.87%(P<0.05)。治疗3和6个月后,观察组中医证候积分、HIF-1αmRNA、NF-κB mRNA及血清TNF-α低于对照组,血白细胞、血小板、血红蛋白及血清IL-1β高于对照组(P<0.05,P<0.01)。治疗期间,2组总不良反应发生率比较差异无统计学意义(P>0.05)。结论三黄三仙汤联合常规西药治疗非重型再生障碍性贫血患者可明显提高临床效果,缓解临床症状,改善血常规。其机制可能为三黄三仙汤通过下调HIF-1α/NF-κB通路上HIF-1α和NF-κB表达,减少TNF-α分泌,加速IL-1β释放,促使机体免疫及造血功能恢复,进而对疾病产生积极作用。

Objective To investigate the clinical efficacy of Sanhuang Sanxian decoction combined with conventional western medicine in the treatment of non-severe aplastic anemia based on the hypoxia-inducible factor-1α(HIF-1α)/nuclear factor-κB(NF-κB)pathway.Methods Ninety-two patients with non-severe aplastic anemia in our hospital from May 2017 to February 2022 were selected and divided into the observation group(n=46)and the control group(n=46)according to different treatment plans.The observation group was given Sanhuang Sanxian decoction combined with conventional western medicine,and the control group was given conventional western medicine.The clinical efficacy at 6 months after treatment,TCM syndrome integral,peripheral blood routine,HIF-1α/NF-κB pathway-related mRNA expression,cytokine[tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)]levels before treatment,and at 3 months and 6 months after treatment and adverse reactions during treatment were compared between the two groups.Results The total effective rate of treatment was higher in the observation group(84.78%vs.60.87%)than in the control group at 6 months after treatment(P<0.05).At 3 and 6 months after treatment,the observation group had lower TCM syndrome integral,HIF-1αmRNA,NF-κB mRNA and serum TNF-α,and higher white blood cell,platelet,hemoglobin,and serum IL-1βthan in the control group(P<0.05,P<0.01).During the treatment,there was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).Conclusion Sanhuang Sanxian decoction combined with conventional western medicine can significantly improve clinical efficacy,relieve clinical symptoms and improve blood routine in patients with non severe aplastic anemia.The possible mechanism is that Sanhuang Sanxian decoction can reduce TNF-αsecretion and accelerate IL-1βrelease by down-regulating HIF-1αand NF-κB expression on the HIF-1α/NF-κB pathway,which can lead to the recovery of the body's immune and hematopoietic functions,thereby producing positive effects on disease treatment.