补肾健脾活血法对重型再生障碍性贫血免疫抑制治疗后早期造血恢复的影响

Effect of Bushen Jianpi Huoxue method on early hemopoietic recovery after immunosuppressive therapy for patients with severe aplastic anemia

关键词:  重型再生障碍性贫血  中西医结合治疗  免疫抑制治疗

Key words:  severe aplastic anemia  combined treatment of traditional Chinese medicine and Western medicine  immunosuppressive therapy

摘要:

[目的] 观察免疫抑制治疗联合“补肾健脾活血”法治疗重型再生障碍性贫血（SAA）临床疗效及对T淋巴细胞亚群的影响，探讨其在促进SAA免疫抑制治疗（IST）后早期造血恢复中的作用机制。[方法] 将60例SAA患者随机分为治疗组和对照组各30例。治疗组予免疫抑制联合中药治疗剂，对照组予免疫抑制联合中药模拟剂。疗程均为3个月，随访至1年。观察两组临床疗效及治疗前后T淋巴细胞亚群变化。[结果] 治疗组总有效率高于对照组，但差异无统计学意义（P>0.05）。治疗后两组外周血细胞计数均较治疗前改善，差异有统计学意义（P<0.05或P<0.01）。治疗组治疗后血红蛋白计数高于对照组，差异有统计学意义（P<0.05）。与治疗前比较，CD3⁺CD4^-CD8⁺/CD3⁺CD19^-细胞比例及CD4⁺CD25⁺Foxp3⁺/CD4⁺CD25⁺细胞比例较治疗前降低，与治疗前相比差异有统计学意义（P<0.05），且CD4⁺CD25⁺Foxp3⁺细胞比例降低与对照组比较，差异有统计学意义（P<0.05）。[结论] 免疫抑制剂联合中医“补肾健脾活血”法治疗SAA疗效确切，其作用机制可能与减少CD8⁺细胞数量，增加CD4⁺细胞数量，提高Foxp3⁺的表达有关。

Abstract:

[Objective] To observe the clinical efficacy of immunosuppressive therapy combined with Bushen Jianpi Huoxue methodfor severe aplastic anemia (SAA) and its effect on T-lymphocyte subsets,and to explore its mechanism in promoting early hematopoietic recovery after IST of severe aplastic anemia.[Methods] Sixty SAA patients with SAA randomly divided into treatment group (n=30)and control group(n=30). The treatment group was treated with IST combined with traditional Chinese medicine therapy,while the control group was treated with IST combined with traditional Chinese medicine simulator. The treatment lasted for 3 months and follow-up visits lasted for 1 year.The clinical efficacy andthe changes of T lymphocytes subsetsbefore and after treatment were observed.[Results] The total effective rate in the treatment group was higher than that in the control group,but there was no significant difference(P>0.05).Aftertreatment,the blood cell counts in the two groups were improved compared with those of before treatment(P<0.05,P<0.01).The hemoglobin of treatment group was significantly higher than that of control group(P<0.05).Compared with the data before treatment in treatment group,the ratio of CD3⁺CD4^-CD8⁺/CD3⁺CD19^- cells and CD4⁺CD25⁺Foxp3⁺/CD4⁺CD25⁺cells decreased(P<0.05),and the ratio of CD4⁺CD25⁺Foxp3⁺ cells was lower than that in the control group(P<0.05).[Conclusion] The combination of IST and Bushen Jianpi Huoxue method is effective in the treatment of SAA,and its mechanism may be related to the decrease of CD8⁺ cells,the increase of CD4⁺ cells and the expression of Foxp3⁺.