摘要
目的 ：探讨成人初治特发性血小板减少性紫癜（ITP）患者中医辨证分型特点,及其与糖皮质激素抵抗、血小板计数、P-糖蛋白表达水平的关系。方法 ：收集成人初治ITP患者58例,流式细胞仪法测定糖皮质激素治疗前后P-糖蛋白表达水平。按血热妄行、阴虚火旺、气不摄血、脾肾阳虚、瘀血内阻辨证分型,4周后分成激素敏感组和激素抵抗组,对两组患者进行辨证分型,分析不同证型与性别、血小板计数、P-糖蛋白表达水平的关系。结果：（1）不同性别的ITP患者同一证型分布差异无统计学意义（P〉0.05）。（2）成人初治ITP患者中医证型以气不摄血型最多见,其次为阴虚火旺型。（3）糖皮质激素治疗后,症状及证型有明显变化,激素敏感组以气不摄血最多见,激素抵抗组以阴虚火旺最多见。（4）血小板计数及P-糖蛋白表达水平在激素敏感组与对照组比较差异有统计学意义（P〈0.05）,激素抵抗组与激素敏感组比较差异有统计学意义（P〈0.05）;激素抵抗组不同证型患者血小板计数及P-糖蛋白表达差异有统计学意义（P〈0.05）。结论：成人ITP中医辨证分型及糖皮质激素抵抗与多项临床指标间存在相关性,对ITP治疗具有参考价值。
Objective：To explore the characteristics of traditional Chinese medicine（TCM） syndrome differentiation type in adult patients with idiopathic thrombocytopenic purpura（ITP）,to investigate their relevance to glucocorticoid resistance,platelet count,P-glycoprotein（P-gp） expression level. Methods：Fifty eighty adult patients with ITP were enlisted,P-gp expression level before and after glucocorticoid therapy were determined by flow cytometry. TCM syndrome differentiation types in patients with ITP were divided into 5 types,blood heat with excessive movement,yin deficiency and excessive fire,qi failing to control blood,yang deficiency of spleen and kidney,and internal blockage of blood stasis. After 4 weeks of glucocorticoid treatment,patients were divided into two types,glucocorticoid sensitive group and glucocorticoid resistant group,TCM syndrome differentiations were conducted in the two groups,to investigate the correlation between TCM syndrome dif ferentiation types to sex,platelet count,P-gp expression level. Results：（1）The difference was not statistically significant in the same TCM syndrome differentiation type between different sex（P 0.05）.（2）Qi failing to control blood was the most common type among TCM syndrome differentiation types in patients with ITP,followed yin deficiency and excessive fire.（3）TCM syndrome differentiation types were changed after glucocorticoid therapy,in which qi failing to control blood was the most common type in glucocorticoid sensitive group,while yin deficiency and excessive fire was the most common type in glucocorticoid resistant group.（4）The difference of platelet count and P-gp expression level were statistically significant between the glucocorticoid sensitive group and the control group（P0.05）,and also between the glucocorticoid sensitive group and glucocorticoid resistant group（P0.05）,as well as among the defferent TCM syndrome differentiation types in the glucocorticoid resistance group（P0.05）. Conclusion：TCM syndrome differentiation types and glucocorticoid resistance are correlated on various clinical indices,which could be a reference for the ITP treatment.
出处
《山东中医杂志》
2018年第2期115-119,共5页
Shandong Journal of Traditional Chinese Medicine
基金
山东省中医药科技发展计划项目(编号:2013-0354)
关键词
成人特发性血小板减少性紫癜
糖皮质激素抵抗
辨证分型
P-糖蛋白表达
idiopathic thrombocytopenic purpura
glucocorticoid resistance
syndrome differentiation
P-glycopro-tein expression level
