【作者】 罗昌国；

【导师】 蒋文明；

【作者基本信息】 湖南中医药大学 ， 中西医结合临床， 2008， 博士

【摘要】 目的：探讨牛角地黄方治疗慢性特发性血小板减少性紫癜(Chronic idiopathic thrombocytopenic purpura, CITP)阴虚血热型的临床疗效和对ITP大鼠的作用机制。方法：1临床研究：将65例慢性特发性血小板减少性紫癜(CITP)阴虚血热型患者,随机分为中药治疗组,西药对照组,分别予牛角地黄方,强的松治疗6个月,对治疗前后病人西医临床疗效、中医证候疗效、出血症状、外周血小板数、骨髓巨核细胞数、不良反应、远期疗效进行比较。2实验研究：采用兔抗大鼠血小板血清(APS)腹腔注射法造模,用免疫荧光技术检测大鼠脾脏巨噬细胞FcγⅡb的表达,用酶联免疫吸附试验(ELISA)检测血清中攻膜复合物(MAC)和抗血小板抗体(PAIgG)的含量,并进行比较。结果：1.临床研究：两组病人在中医证侯疗效、西医临床疗效、血小板数量、骨髓巨核细胞改善方面治疗前后比较均有显著性差异(P<0.05)；在中医证候疗效、远期疗效和五心烦热、口干、便秘3个单一症状改善方面治疗组优于对照组,差异有统计学意义(P<0.05)；在血小板上升速度和头晕目眩症状改善方面治疗组比对照组差,差异有统计学意义(P<0.05)；在西医临床疗效、血小板数量、出血症状改善、骨髓巨核细胞变化几个方面治疗组与对照组比较无显著性差异(P>0.05)；经观察1年,治疗组未见有明显心、肝、肾等脏器毒副反应。2.实验研究：三组大鼠脾脏巨噬细胞FcγRⅡb的表达顺序是药物组>空白组>模型组,统计学分析药物组与空白组和模型组均有显著性差异(P<0.05),空白组与模型组无显著性差异(P>0.05)；两组大鼠血清中MAC含量比较无显著性差异(P>0.05),血清中抗血小板抗体(PAIgG)的含量药物组比模型组高,统计学分析有显著性差异(P<0.05)。结论：1牛角地黄方能有效提升CITP阴虚血热型患者血小板数量和改善出血症状,安全性高,远期疗效优于强的松,但提升血小板速度比强的松慢。2牛角地黄方通过上调脾脏巨噬细胞FcγRⅡb和干预自身抗体与血小板结合从而阻止血小板被破坏。更多还原

【Abstract】 Objective:to discuss the clinical curative effect of NiuJiaoDiHuan decoction on treatment of Chronic idiopathic thrombocytopenic purpura with YinXuXueRe and it’s mechanism on ITP experimental ratsMethods:1 Clinical Study:65cases of patients with CITP were divided into two groups randomly (Chinese medicine treatment group, western medicine control group), and were treated with NiuJiaoDiHuan decoction, Prednisone respectively for 6 months. The curative effect, Chinese medical syndromes, clinical efficacy, blood platelet, megakaryocyte of bone marrow, side effect, and prostecdtive efficacy were observed. Moreover, all of above were compared between treatment and control group.2 Experimental Study:Abdominal cavity injection of APS was given everyday to rats for the mode of ITP. Through the rat mode of ITP,Fc gamma receptor II b (FcγII b) on Spleen Macrophage were tested by Immunity fluorescence technology,Membrane attack complexe (MAC) and Blood platelet related immune body (PAIgG) on Blood serum were tested by ELISA. Results:1 Clinical Study:About Chinese medical syndromes, clinical efficacy, blood platelet, megakaryocyte of bone marrow,the results showed there were Obvious curative effect compared to treatment before on the two groups patients (P< 0.05); NiuJiaoDiHuan decoction treating CITP made better to the therapeutic group than the control group about Chinese medical syndromes, prostecdtive efficacy,Wuxingfangre,mouth does, constipation (P< 0.05),but showed a contrary results about increasing velocity of blood platelet, Dizziness (P< 0.05). About clinical efficacy, Quantity of blood platelet, megakaryocyte of bone marrow and Hemorrhage symptom, there were no significant difference between the two groups (P> 0.05);After been observating for one year, obvious side effect on the patients of therapeutic group were not discovered.2 Experimental Study:In the three groups rat mode of ITP,the sorting of the expression of the FcγⅡb on Spleen Macrophage is medicine group>normal group>model group, moreover, there is significant difference of the expression of the Fc y II b on the medicine group compared with the other two groups (P< 0.05),but there is no statistic significance between the normal group and the model group (P>0.05).There is no statistic significance of the quantity of the MAC on Blood serum between the medicine group and the model group(P>0.05), but about the PAIgG, the diffrence between the two groups is significant (P<0.05)。Conclusion:1 NiuJiaoDiHuang decoction is effective in treating chronic idiopathic thrombocytopenic purpura with YinXuXueRe, and it has characters as wide safety scope and good security utilities,and the prostecdtive efficacy of NiuJiaoDiHuang decoction is better than Prednisone’s,but inferior to prednisone in increasing velocity of blood platelet.2 The mechanism of the NiuJiaoDiHuang decoction in preventing blood platelet from the destruction is to increase the expression of the Fc y II b on Spleen Macrophage and intervent the combine of the PAIgG to blood platelet.更多还原