补肾益髓生血颗粒治疗慢性再生障碍性贫血疗效及调控端粒机制研究

Efficacy of Bushen Yisui Shengxue Granule on Chronic Aplastic Anemia and Its Mechanism of Telomere Regulation

目的:观察补肾益髓生血颗粒对慢性再障患者疗效及对端粒长度、端粒酶相关蛋白角化不良蛋白(dyskerin)mRNA表达的影响,探讨补肾益髓生血颗粒对慢性再障造血功能的干预效应。方法:选取我院收治的慢性再障患者60例,随机分为治疗组30例,对照组30例。其中,治疗组给予补肾益髓生血颗粒加西医基础治疗,对照组给予西医基础治疗,分析两组患者治疗后的临床疗效、中医证候积分,以及端粒长度及Dyskerin mRNA表达。结果:治疗组总有效率(76.7%),明显高于对照组(60%)(P<0.05)。中医证候积分的改善,治疗组优于对照组(P<0.05)。与治疗前比较,治疗后两组患者WBC、Hb、PLT明显升高(P<0.05),其中治疗后治疗组Hb显著高于对照组(P<0.05)。治疗后骨髓造血细胞面积两组患者均较治疗前明显提高(P<0.05),且治疗组显著高于对照组(P<0.05)。治疗后端粒长度对照组较治疗组明显缩短(P<0.05)。治疗后Dyskerin mRNA表达情况对照组较治疗组明显下调(P<0.05)。结论:补肾益髓生血颗粒联合雄激素及环孢素A可进一步提高慢性再障的临床疗效,改善骨髓造血功能,机制之一可能是通过提高端粒酶活性或抑制端粒缩短实现的。

Objective: To analyze the efficacy of Bushen Yisui Shengxue Granule on patients with chronic aplastic anemia, its impact on telomere length and mRNA expression of telomerase related protein dyskerin, and also to investigate the intervention effect of Bushen Yisui Shengxue Granule on hematopoietic function in patients with chronic aplastic anemia. Methods: 60 patients with chronic aplastic anemia in our hospital were selected and divided into the treatment group and the control group. Patients in the control group were treated with conventional western medicine, while patients in the treatment group were treated with Bushen Yisui Shengxue Granule combined with conventional western medicine. After treatment, we analyzed the clinical efficacy and TCM syndrome scores in the two groups, the telomere length and dyskerin expression were detected by qRT-PCR. Results: The total effective rate in the treatment group(76.7%) was higher than that in the control group(60%)(P<0.05). The improvement of TCM syndrome score in the treatment group was better than that in the control group(P<0.05). WBC, Hb and PLT in the two groups were significantly increased than those before treatment(P<0.05),and Hb in the treatment group was significantly higher than that in the control group(P<0.05). The composition of bone marrow hematopoietic cells in the two groups after treatment was significantly higher than that before treatment(P<0.05), and it in the treatment group was significantly higher than that in the control group(P<0.05). The telomere length in the control group was significantly shorter than that in the treatment group after treatment(P<0.05). The expression of dyskerin mRNA in the control group was significantly down regulated than that in the treatment group after treatment(P<0.05). Conclusion: Bushen Yisui Shengxue granule combined with androgen and cyclosporin A can further improve the clinical efficacy for chronic aplastic anemia, it can improve the hematopoietic function of bone marrow. One of the mechanisms may be related to increasing telomerase activity or inhibiting telomere shortening.