小柴胡汤加二至丸治疗难治性免疫性血小板减少症后血小板参数的变化

Changes of Platelet-Associated Parameters in Patients with Refractory Immune Thrombocytopenia Treated with Xiaochaihu Decoction and Erzhi Pill

目的观察肝肾阴虚、肝经蕴热型难治性免疫性血小板减少症患者接受中药治疗后血小板及其相关参数的恢复过程。方法将肝肾阴虚、肝经蕴热型难治性免疫性血小板减少症患者按对激素治疗的反应分为激素依赖组和激素抵抗组。2组均给予自拟“小柴胡汤加二至丸”进行治疗,激素依赖组需给予小剂量激素维持治疗,2组均治疗3个月,并于治疗前、治疗后15、30、60、90 d分别检测外周血细胞计数,记录血小板计数(platelet count,PLT)、平均血小板体积(mean platelet volume,MPV)、血小板分布宽度(platelet distribution width,PDW)、大血小板比值(platelet large cell ratio,LCR)4项参数。应用重复测量的统计方法建立血小板及相关参数的恢复过程模型。结果单因素统计分析显示中药治疗可以改变血小板及其相关参数(P<0.05)。多元统计分析显示激素依赖组的血小板计数和大血小板比例参数恢复情况优于激素抵抗组(F=55.696,P<0.001;F=6.302,P=0.019),血小板计数和大血小板比例的时间效应差异有统计学意义(F=27.530,P<0.001;F=3.980 P=0.041),并且变化过程遵循线性趋势(F=50.071,P<0.001;F=5.046,P=0.034),血小板计数的时间因素和组别因素间存在交互作用(F=37.670,P<0.001),但平均血小板体积和血小板分布宽度的组别效应和时间效应差异均无统计学意义(P>0.05)。结论小柴胡汤加二至丸治疗可改变血小板参数,激素依赖组较激素抵抗组血小板恢复较快,提示激素抵抗组临床治疗难度较大。

Objective To observe the recovery process of platelet and its associated parameters in patients with refractory immune thrombocytopenia of deficiency of liver yin and kidney yin and liver-contains-heat pattern treated with traditional Chinese medicine.Method According to clinical response to hormone therapy,the refractory immune thrombocytopenia patients of liver and kidney Yin-weak and liver-contains-heat pattern were divided into hormone-dependent group and hormone-resistant group.Patients in both groups were given traditional Chinese medicine of“Xiaochaihu decoction plus Erzhi pill”.Patients in hormone-dependent group were given a small dose of the hormone at the same time.Both groups were treated for three months.Peripheral blood cell count was detected before treatment and on the 15th d,30th d,60th d,and 90th d after treatment.Platelet count,mean platelet volume,platelet distribution width and large platelet ratio were recorded.Platelet and associated parameters recovery process model were established by repeated measures statistical methods.Results Univariate analysis showed platelets and associated parameters could be changed by Chinese medicine treatment(P<0.05).Multivariate statistical analysis showed that platelet count(PLT)and platelet large cell ratio(LCR)of hormone-dependent group were better than those of hormone resistance group(F=55.696,P<0.001;F=6.302,P=0.019).Time effect of platelet count and platelet large cell ratio were statistically significant(F=27.530,P<0.001;F=3.980,P=0.041),and this evolution followed a linear trend(F=50.071,P<0.001;F=5.046,P=0.034).There was an interaction between time factors and group factors in platelet count(F=37.670,P<0.001).Group effects and time effects of mean platelet volume and platelet distribution width had no statistical significance(P>0.05).Conclusion Therapy of Xiaochaihu decoction plus Erzhi pill can significantly alter platelet parameters.Platelet recovery in hormone dependent group is faster than that in hormone resistance group,which indicates that clinical treatment in hormone resistance group is more difficult.