益气养血方联合西医治疗难治性血小板减少症疗效及对血小板膜糖蛋白CD41、CD61水平影响

Clinical efficacy of integrated treatment （Yiqiyangxue compound and Western medicine） on RITP and the changes of platelet membrane glycoprotein CD41 and CD61

[目的]探讨中西医结合治疗难治性免疫性血小板减少症（RITP）的临床疗效及治疗前后患者血小板膜糖蛋白CD41、CD61水平变化特点。[方法]选取2010年5月至2014年12月本院收治的78例RITP患者，随机分为对照组与观察组，每组39例，对照组给予强的松片口服，观察组给予强的松片＋益气养血方联合治疗。治疗6个月后，比较两组临床疗效，治疗前后血小板计数，血小板膜糖蛋白CD41、CD61及T细胞亚群变化。[结果]治疗后观察组总有效率显著高于对照组，差异具有统计学差异（χ^2=20．146，P〈0．05）；治疗后两组PLT、PCT、CD41、CD61均明显高于治疗前水平（P〈0．05），且观察组升高幅度高于对照组（P〈0．05））治疗后两组CD3^＋、CD4^＋、CD4^＋／CD8^＋均明显高于治疗前，CD8^＋明显低于治疗前（P〈0．05），且观察组变化幅度大于对照组（P〈0．05）；与对照组比较，观察组患者糖皮质激素副作用有明显改善（P〈0．05）。[结论]中西医结合治疗RITP临床疗效优于单纯西药治疗，可改善患者细胞免疫功能及降低糖皮质激素副作用，提高血小板膜糖蛋白CD41、CD61水平。

[Objective] To investigate the clinical efficacy of integrated traditional Chinese and Western medicine in the treatment of refractory immune thrombocytopenia （RITP） and the level changes of platelet membrane glycoprotein CD41 and CD61 before and after treatment.[Methods] Seventy-eight cases of RITP in our hospital from May 2010 to December 2014, were randomly divided into control group and observation group, 39 cases in each group.The control group was given prednisone tablets, and the observation group was given the combined treatment prednisone tablets ＋ yiqiyangxue decoction. After 6 months of treatment, the clinical effects of the two groups and the changes of platelet count, platelet membrane glycoprotein CD41, CD61 and T cell subsets were compared before and after treatment. [Results] After treatment, the total efficiency of the observation group was significantly higher than the control group, the statistical difference was significant （χ^2 =20.146, P 〈0.05） ; After treatment, PLT, PCT, CD41, CD61 of the two groups were significantly higher than those before treatment （ P 〈0.05）, and the increase rate of the observation group was higher than that of the control group （ P 〈0.05） ; After treatment, CD3^＋ ,CD4^＋ ,CD4^＋/ CD8^＋ of the two groups were significantly higher than those before treatment, CD8^＋ was significantly lower than that before treatment （ P 〈0.05）, the change rate of the observation group was greater than that of the control group （ P 〈0.05）; Compared with the control group, the side effects of glueocorticoid in the observation group were significantly improved （ P 〈0.05）.[Conclusion] The clinical efficacy of combination of traditional Chinese and Western medicine for treatment of RITP is better than simple western medicine treatment. The integrated therapy can improve the cellular immune function of patients and reduce the side effects of glucocorticoid, and improve the level of platelet membrane glycoprotein CD41 and CD61.