再生障碍性贫血临床实践指南研究现状及中医指南的修订与思考

再生障碍性贫血(简称再障)经过100多年的认知和临床实践,治疗水平得到飞速发展。随着中医诊疗水平的发展以及中医药规范化工作的推进,建立和优化再障中医诊疗指南具有特殊的意义。回顾了国内外近20年再障临床实践指南的现状,分析了各指南形成的背景、特点及差异,结合目前再障中医诊疗指南/共识的特点,论述了中医指南修订的价值、特点和可以借鉴的方法。     

再生障碍性贫血“瘀证”与铁过载的相关性探讨

铁过载和中医“血瘀证”在再生障碍性贫血（简称再障）的发生发展中发挥着重要作用。围绕再障“瘀证”的发生机制和临床特征,结合中医“取象比类”和相关临床基础研究进展,系统阐述了铁过载与再障中医“瘀证”潜在的相关性。铁螯合治疗契合“祛瘀生新”的中医理论,有利于改善造血,而从中医“补肾活血”着手,同样有助于疾病临床疗效的提升。     

“痰瘀同治”法对再生障碍性贫血小鼠骨髓有核细胞凋亡的影响及其机制

目的：探讨＂痰瘀同治＂法对再生障碍性贫血小鼠骨髓有核细胞凋亡的影响及其相关机制。方法：复制免疫介导的再生障碍性贫血（AA）小鼠模型,取其血清诱导正常小鼠骨髓有核细胞的凋亡过程;同时用中药（单纯补肾、补肾祛痰瘀）灌给的大鼠血清作为治疗因素,体外共培养24h,观察有核细胞凋亡率、细胞内Caspase-3酶活性及Bax蛋白表达水平。结果：AA小鼠血清处理后,正常小鼠骨髓有核细胞凋亡率显著提高（P〈0.01）,两治疗组均能显著减轻AA小鼠血清的凋亡诱导作用（P〈0.01）,抑制AA血清诱导下骨髓有核细胞内Caspase-3酶活性（P〈0.05）,且以补肾祛痰方药的作用更明显（P〈0.05）;两治疗组均能显著降低骨髓细胞的Bax蛋白阳性强度与阳性率乘积（P〈0.05）,但两组间无显著性差异。结论：AA小鼠血清能显著诱导骨髓造血细胞的凋亡过程,两治疗组均能通过Caspase-3/Bax途径起到抑制作用,且以补肾祛痰瘀较为显著,但两者疗效的差异与Bax无显著相关性。     

浅谈急性再生障碍性贫血的“痰瘀同治”观

再生障碍性贫血(简称再障)又有急性再障和慢性再障之分,前者即重型再障Ⅰ型.按发病特点中医学将其纳入"急劳"、"热劳"、"髓劳"范畴,认为先天禀赋不足或劳伤体气,邪气热毒乘虚而入,中伤骨髓精气,以令精血生化乏源、髓骨亏空是总的发病机理.结合多年的临床经验,我们认为,急性再障初期虽病情危重,尚处邪盛正不虚之阶段,以清解热毒,祛邪外出为要是明智的,而若在此基础上酌加祛痰化瘀之品,则将收获更好的治疗效果.     

不同中医证候患者接受骨髓血管再生术治疗的表现与再生障碍性贫血临床病理特征联系

Objective： To explore differences in bone marrow angiogenesis seen in aplastic anemia （AA） patients presenting with differential Chinese medicine （CM） syndrome, and to correlate these differences with clinical pathology. Methods： Thirty-five patients were enrolled, including 18 with ＂yang deficiency syndrome＂ and 17 with ＂yin deficiency syndrome.＂ Bone marrow biopsies and serum were collected. Microvessel density （MVD） and positive expression of vascular endothelial-derived growth factor （VEGF） were detected by immunohistochemisty. Hypoxia inducible factor -α （HIF-α ）, and VEGF expression were assayed by enzyme-linked immunoabsorbent assay （ELISA）, serum lactate dehydrogenase （LDH） was tested by enzyme method and liquid chip technology was used to detected the expression of interleukin （IL）-2, IL-4, IL-6, IL-10, interferon （IFN）-＇y and tumor necrosis factor （TNF）-α. Results： Counts for leukocytes, absolute neutrophils and platelets in ＂yin deficiency syndrome＂ were lower than those found in ＂yang deficiency syndrome＂ （P〈0.05）. MVD and VEGF expression, and the positive rate of CD34 and VEGF in bone marrow were lower in hA, especially in ＂yin deficiency syndrome＂ （P〈0.01 or P〈0.05）. ＂Yin deficiency syndrome＂ displayed decreased VEGF and LDH expression, and enhanced expression of HIF-α as compared to ＂yang deficiency syndrome＂ （P〈0.05）. Levels of IL-4 and IL-6 were higher in AA （P〈0.01）, but IL-10 was decreased （P〈0.05）. High TNF-c~ expression was seen in ＂yang deficiency syndrome＂ and IFN- γ expression was decreased in ＂yin deficiency syndrome＂ as compared with normals （P〈0.01 and P〈0.05, respectively）. Conclusion： AA patients have lower MVD than normals, especially in ＂yin deficiency syndrome.＂ MVD might differentially correlate to disease severity, and could be dependent on bone marrow or serum VEGF expression and LDH. Additionally, IL-2, IL-10, IL-4 and IFN- γ were negatively associated while IL-6 and TNF- α were positively associated with MVD.     

细胞黏附分子在重症急性胰腺炎并发急性肺损伤中的作用

细胞黏附分子(cell adhesion molecule,CAM)是一类介导细胞与细胞、细胞与细胞外基质问相互结合的重要活性物质,参与细胞的识别、活化、增生、分化、移动等过程,是免疫应答、炎症反应、凝血、肿瘤转移等一系列生理和病理过程的分子基础.     

中药治疗重症急性胰腺炎机制研究进展

急性胰腺炎(acute pancreatitis,AP)是临床常见的急腹症,重症急性胰腺炎(severe acute pancreatitis,SAP)亦称急性坏死性胰腺炎(acute necrotic pancreatitis,ANP),病死率较高,约有20%[1].     

骨髓增殖性疾病的认知和治疗

骨髓增殖性疾病(myeloproliferative disorders,MPD)是起源于骨髓造血干细胞的一组克隆性疾病,表现为骨髓中一系或多系血细胞增殖,外周血出现过多的成熟或幼稚细胞.     

骨髓增殖性疾病的认知和治疗

骨髓增殖性疾病(myeloproliferative disorders,MPD)是起源于骨髓造血干细胞的一组克隆性疾病,表现为骨髓中一系或多系血细胞增殖,外周血出现过多的成熟或幼稚细胞.