补肾活血通络法对慢性再生障碍性贫血患者骨髓CD_(34)^+细胞凋亡的影响

EFFECT OF TONIFYING KIDNEY AND REMOVING OBSTRUCTION IN CHANNELS METHOD ON THE APOPTOSIS OF CD_(34)^+ CELLS IN BONE MARROW OF PATIENTS WIH CHRONIC APLASTIC ANIMIA

目的 :探讨补肾活血通络法治疗慢性再生障碍性贫血 (简称CAA)的临床疗效及作用机理。方法 :将 79例CAA患者随机分为治疗组和对照组。对照组单用西药治疗 ,治疗组用补肾活血通络方加西药治疗。并分别于治疗前后采用免疫磁珠分离系统 (MACS)分离纯化骨髓CD3 4 +细胞 ;用DNA末端原位标记(TUNEL)技术分析骨髓CD3 4 +细胞原位凋亡状况。结果 :治疗组与对照组的基本治愈率、缓解率、总有效率分别为 37 5 0 %、2 5 0 0 %、87 5 0 %和 2 0 5 1%、17 95 %、6 1 5 4 %。两组疗效比较有显著性差异 (P <0 0 1)。治疗前两组骨髓CD3 4 +细胞的凋亡率较健康对照组明显增高 (P <0 0 1) ,治疗后治疗组骨髓CD3 4 +细胞的凋亡率较治疗前明显减低 (P <0 0 1) ,与对照组比较有显著性差异 (P <0 0 1)。结论 :补肾活血通络法治疗CAA疗效高、毒副作用少。其作用机制可能是通过阻抑CAA患者造血细胞的过度凋亡 ,使骨髓造血功能重建。

Objective:To study the clinical effect of tonifying kidney and removing obstruction in channels method on treating chronic aplastic anemia(CAA) and its mechanism.Method:79 patients with CAA were randomly dividided in to two groups,40 cases in the treatment group were given Chinese herbs plus western medicine,39 cases in the control group only.given western medicine.CD 34 + cells of bone marrow were separated respectively with mun omagnetic beads (MACS) before and after treatment.their apoptosis were analysised with DNA in situ end labeling. Results:The cure rate,remission rate,total effetive rate of the treatment and control group were 37 50%,25 00%,87 50% and 20 51%,17 95%,61 54% respectively.There was significant difference between the two groups( P <0 01).The apoptosis rate of CD 34 + cells was higher in treatment group than that of control group( P <0 01) before treatment. The apoptosis rate was lower after treatment.than before ( P <0 01).There was significant difference between two groups ( P <0 01). Conclusion:The clinical effect of tonifying kidney and removing obstruction in channels method on CAA was good,and its toxicity was small.It was suggested that the method might inhibit over-apoptosis of CD 34 + bone marrow cells so as to promote bone marrow to rebuild hematopoietic function.