糖皮质激素治疗原发免疫性血小板减少证候特征系统综述

Systematic Summarize of Glucocorticoid Treatment of Primary Immune Thrombocytopenia Syndrome Characterized

[主要目的]分析糖皮质激素治疗原发免疫性血小板减少证候特征。[资料来源]选取新疆医科大学附属中医院及新疆自治区人民医院血液科2011年12月至2013年9月ITP住院患者,制定中医证候观察表。[选择文献量及依据]①年龄16-81岁。②符合ITP西医诊断标准。③干预方法：糖皮质激素,强的松片,1mg/（kg·d）,连续治疗4周,逐步减量。④知情同意,签署知情同意书。排除严重出血如颅内出血;严重心、肝、肾并发症或合并其它原发性疾病和精神病;依从性差,不按规定用药而影响观察;糖尿病及其他有使用糖皮质激素禁忌症。[数据提炼规则及应用方法]根据中医证候观察表,分析治疗前后症状、舌苔、脉象、证型等,将结果如实记录到中医症候观察表,分析糖皮质激素治疗前后的症状分布以及证型分布。使用Excel2010软件建立数据库,将ITP患者出现的症状、年龄分布、症状变化、证型分布进行例数统计,计算频率。[数据综合得出结果与结论]①年龄主要分布在16-81岁之间共113例,男27例,女86例,男：女=1：3.19。②使用激素治疗前后主要症候包括神疲乏力、头晕目眩、食少纳呆、面色无华、少气懒言、大便干、盗汗、五心烦热、咽痛、颧红、肌肤甲错、面色暗黑、心慌等。③糖皮质激素治疗前证型以气不摄血（35.40%）,气阴两虚（25.10%）居多。糖皮质激素治疗后证型以阴虚火旺（34.51%）为多,气阴两虚（24.55%）,气不摄血（14.16%）。④共有75例患者糖皮质激素治疗有效,治疗前证型分布：气不摄血（37.84%）〉气阴两虚（21.62%）〉脾肾阳虚（13.51%）〉阴虚火旺（10.81%）〉血热妄行（2.70%）。ITP糖皮质激素使用前,证型分布与现行证型分布基本一致。并且还有气阴两虚、脾肾阳虚两种证型占较大比例;糖皮质激素治疗后,症状、证型有明显变化,以阴虚火旺型为多;糖皮质激素治疗有效的病例在治疗前的证型分布,以气不摄血、气阴两虚型为多。[未来展望]糖皮质激素治疗ITP患者中医证候类型不是一成不变,未来明确中医证候特征并辨证治疗能提高机体对激素敏感性及增强激素疗效,可拮抗激素副作用、并发症及撤减激素后反跳现象,有广阔的研究前景。

[ Main Object ] Analysis of glucocorticoid treatment of primary immune thrombocytopenia syndrome features. [ Source ] Selected the ITP hospitalized patients develop syndromes observed table, from December 2011 to September 2013 of Affiliated Hospital of Xinjiang Medical University and Xinjiang Autonomous Region People＇s Hospital Hematology. [ Literature Selection and Criterion ] ① aged 16 to 81 years old.② comply with ITP Western diagnostic criteria. ③ interventions：corticosteroids, prednisone tablets, l mg/kg/d, continuous treatment for 4 weeks, gradually reducing.④ informed consent, informed consent. Exclusion of serious bleeding, such as intracranial hemorrhage;severe heart, liver, kidney complications or combined with other primary diseases and mental illness;poor compliance, but are not required to observe the effects of medication; diabetes and other corticosteroids contraindications. [ Data Extracting and Method ] waiting tables according to TCM observe, analyze symptoms before and after treatment, tongue, pulse, and other syndromes, the results accurately recorded TCM symptoms observed table, analyze the distribution of symptoms and syndromes before and after glucocorticoid therapy distribution. Use Excel2010 software to establish a database of the symptoms of ITP patients, age distribution, changes in symptoms, syndromes statistical distribution of the number of cases, to calculate the frequency. [ Results and Conclusions ] ① aged mainly between 16 to 81 years in total 113 cases, 27 males and 86 females, male：female = 1 ： 3.19 . ② the use of hormone therapy before and after the main symptoms include lassitude, dizziness, poor appetite, minimalist looking, less qi lazy words, dry stool, night sweats, five upset hot, sore throat, zygomatic red, skin a mistake, dark complexion, palpitation and so on. ③ glucoeorticoid therapy before syndromes with qi failing to control blood （ 35.40% ）, deficiency of both qi and yin （ 25.10% ） majority. Glucocorticoid therapy syndromes to hyperactivity of fire due to yin deficiency （ 34.51% ） as much, deficiency of both qi and yin （ 24.55% ）, qi failing to control blood （ 14.16% ） . A total of 75 patients ④ glucocorticoid therapy effective treatment before the syndrome distribution：qi failing to control blood （ 37.84% ） 〉deficiency of both qi and yin （ 21.62% ） 〉 spleen deficiency （ 13.51% ） 〉hyperactivity of fire due to yin deficiency （ 10.81% ） 〉blood-heat bleeding （ 2.70% ） . ITP before glucocorticoid use, distribution and existing syndromes syndrome distribution basically the same. And there deficiency of both qi and yin, spleen deficiency syndromes account for a large proportion of the two ; after glucocorticoid treatment, symptoms, syndromes significant change to hyperactivity of fire due to yin deficiency ; cases glucocorticoid therapy effective in the pre-treatment of the syndrome distribution to qi failing to control blood, deficiency of both qi and yin type as much. [ Future Prospects ] In the process of glucocorticoid treatment of ITP, TCM syndrome types of patients is not a constant, clarify its syndrome characteristics of traditional Chinese medicine and syndrome differentiation treatment can improve the body＇s sensitivity to hormones and enhancing hormone curative effect, side effects, complications can adersely affect hormones and shut down after hormone bounce phenomenon, clinical curative effect is distinct, there are broad prospects for research.