从脾胃论治成人难治性特发性血小板减少性紫癜初探

Exploration on Treating Adults' Refractory Idiopathic Thrombocytopenic Purpura from Spleen and Stomach

目的:观察以脾胃为本辨证施治治疗成人难治性特发性血小板减少性紫癜的疗效,同时观察Hp感染在治 疗前后的变化。方法:以补脾和胃滋阴养血为法,佐以清胃祛瘀,自拟方药随证加减,用酶联免疫法(ELISA)检测治疗前后 粪便幽门螺旋杆菌特异性抗原(HpSA)。结果:显效1例、良效3例、进步3例、无效2例。有效率77％。Hp感染4例治疗 前阳性,其中2例治疗后转阴。结论:以脾胃为本辨证施治治疗成人难治性特发性血小板减少性紫癜疗效明显,Hp感染 与难治性特发性血小板减少性紫癜的关系有待进一步深入观察。

Recent studies of foreign researchers have suggested that Helicobacter pylori （H pylori） infection has prevalence with idiopathic thrombocytopenic purpura （ITP）, especially with refi＇actory idiopathic thrombocytopenic purpura （R.ITP）. So we determined to observe the effect of pure TCM treatment based on gastro-spleen theory on adult refractory idiopathic thrombocytopenic purpura patients and the change of H pylori infection before and after treatment. 9 adult patients were enrolled during 2003-9 to 2004-12, H pylori infection v-as found in 4 patients by means of ELISA test of Hp stool antigen （HpSA） in feces. TCM treatment methods： strengthen spleen, regulate stomach, nourish yin and blood, clear gastro-heat, and remove blood stasis. After 4 months, one patient＇s platelet count was found〉100×109/L, three〉50×109/L or rose 30×109/L than before, three got some rise in platelet count, two had no response, total response rate was 77.7%. Two of the 4 H pylori-positive patients were found negative in HpSA test. In conclusion, TCM therapy based on gastro-spleen theory has observantly effect on RITP, but the prevalence of H pylori infection was needed further study.