特发性血小板减少性紫癜患者GR亚型的表达及生血灵干预研究

GR subtype expressions in patients with idiopathic thrombocytopenic purpura and its treatment with "Sheng Xue Ling"

目的探讨特发性血小板减少性紫癜(ITP)患者糖皮质激素受体(GR)α和β亚型的表达情况及生血灵的调节作用。方法对63例ITP患者采用生血灵治疗,疗程6个月。观察临床疗效及治疗前后血小板计数变化情况;以20名健康成人为正常对照,应用免疫细胞化学方法分别检测不同激素效应ITP患者在生血灵治疗前后GRα和GRβ免疫阳性的外周血单个核细胞(PB-MC)数目变化情况。结果63例ITP患者经生血灵治疗6个月后,总有效率达82.5%;敏感阳虚型、敏感阴虚型、抵抗阳虚型血小板计数治疗后明显提高(P<0.05),抵抗阴虚型治疗前后差异无统计学意义(P>0.05)。正常对照组和ITP患者PBMC内同时有GRα和GRβ的表达,并以GRα表达为主,ITP患者GRα表达较正常对照组明显下降(P<0.05),激素抵抗型ITP患者GRβ表达明显高于激素敏感型和正常对照组(P<0.05);患者治疗后GRα阳性细胞数较治疗前升高,GRβ下降(P<0.05)。结论ITP患者PBMC内GRα和GRβ表达比例失调,GRα表达下降、GRβ表达亢进可能是ITP激素抵抗的主要机制;生血灵能调节GRα和GRβ的比例失衡,是治疗激素抵抗型ITP、改善激素抵抗状态的有效方剂。

Objective To observe the expressions of glucocorticoid receptor-α （GRα） and glucocorticoid receptor-β （GRβ） in patients with idiopathic throbocytopenic purpura（ITP） and its intervention by ＂Sheng Xue Ling＂. Methods Sixty-three ITP patients were treated with ＂Sheng Xue Ling＂ for six months; the clinical efficacy and platelet counts were observed after treatment. Twenty healthy people were enrolled as control. Immunocytochemical method was used to detect peripheral blood mononuclear cells （PBMC） in patients With immunologically positive GRα and GRβ. Results The total effective rate was 82.5%. After treatment, the platelet count obviously increased in patients of sensitive yang-deficiency type, sensitive yin-deficiency type and resistant yang-deficiency type（ P 〈0.05 ）, and remained unchanged in resistant yin-deficiency type（P 〉0.05）. GRα and GRβ expressions existed in ITP patients and healthy people, mainly by GRα. The peripheral blood mononuclear cells （PBMC） of the glucocorticoid sensitive type and the glucocorticoid resistant type with ITP patients decreased significantly （P 〈0.05） ; the number of GRβ of the glucocorticoid resistant type was much more than the glucocorticoid sensitive type and the control group （P 〈0.05 ）. Conclusion The disproportion of GRα and GRβ expressions happens in patients with ITP, GRα expression decreasing and GRβ expression increasing, which may play an important role in the pathology of ITP and the glucocortieoid resistant type. ＂Sheng Xue Ling＂ can balance GRα and GRβ expressions to treat glucocorticoid resistant ITP.