益气养血补肾方联合康力龙治疗重型再生障碍性贫血的疗效和机制探讨

To Investigate the Effect and Mechanism of Yiqi Yangxue Bushen Decoction Combined with Stanozolol in Treatment of Severe Aplastic Anemia

目的探讨益气养血补肾法中药制剂联合康力龙治疗重型再生障碍性贫血的作用机制。方法选取2014～2017年在北京中医药大学东方医院就诊的重型再生障碍性贫血患者,根据治疗方法分为治疗组和对照组,两组均纳入31例,对照组采用康立龙、环孢素A治疗,治疗组在对照组治疗基础上增加使用中药方气养血补肾治疗,两组治疗期间均采用相同辅助治疗,疗程6个月。观察治疗前后患者T淋巴细胞亚群(CD3+、CD4+、CD8+)、辅助性T淋巴细胞Th1、Th2、造血正负调控因子(IL-4、IFN-α)等指标的变化情况。结果治疗组总有效率90.32%,显著高于对照组;差异有统计学意义(P <0.05);各组CD8+均较治疗前下降,CD4+/CD8+值升高,两组间比较差异有统计学意义(P <0.05),CD3+、CD4+治疗前后比较无明显差异(P> 0.05);治疗后两组Th1、Th1/Th2比值均降低,治疗组降低幅度大于对照组(P <0.05)。Th2较治疗前无明显变化;治疗后两组IFN-γ数量降低,且治疗组降低幅度大于对照组(P <0.05),IL-4数量有所提高,差异不明显。结论益气养血补肾方联合康力龙治疗重型再生障碍性贫血临床疗效显著,其作用机制可能与调节相关的造血调控因子以及T淋巴细胞亚群数量有关。

Objective To explore the mechanism of Yiqi Yangxue Bushen preparation combined with Stanozolol in the treatment of severe aplastic anemia.Methods The patients with severe aplastic anemia in our hospital from 2014 to 2017 are divided into the treatment group and the control group according to the treatment methods.The two groups are all included in 31 cases.The control group is treated with stanozolol and cyclosporine A,while the treatment group is treated with traditional Chinese medicine Qi Yangxue Bushen decoction the basis of the control group.Both groups are treated with the same adjuvant therapy during the treatment period.The course of treatment is 6 months.The changes in the number of T lymphocyte subsets(CD3+,CD4+,CD8+),Th1 and Th2 in the auxiliary T lymphocyte,the positive and negative regulatory factors of the hematopoiesis(IL-4,IFN-α)are observed before and after treatment.Results The total effective rate of the treatment group is 90.32%,significantly higher than that of the control group(P<0.05);the CD8+in each group is lower than that before the treatment,the CD4+/CD8+ratio is higher,the difference between the two groups is statistically significant(P<0.05),there is no statistical difference before and after treatment with CD3+and CD4+(P>0.05).After treatment,the two groups of Th1 and the ratio of Th1/Th2 decreased,and the reduction of the treatment group is greater than that of the control group(P<0.05).There is no significant change in Th2 after treatment.The number of IFN-γdecreased after treatment and the degree of change in the treatment group is greater than that of the control group(P<0.05).The number of IL-4 increased and the difference is not obvious.Conclusion The effect of Yiqi Yangxue Bushen recipe combined with stanozolol in the treatment of severe aplastic anemia is significant,and its mechanism may be related to the regulation of the number of T lymphocyte subsets and related hematopoietic regulation factors.