特发性血小板减少性紫癜中医药治疗概述

特发性血小板减少性紫癜属于中医的血汪、发斑等范畴,认为其以热证、虚证、瘀证为主.现将近年来中医药治疗ITP现状综述如下.     

重症特发性血小板减少性紫癜的治疗体会

目的探讨常规剂量强的松并输注浓缩血小板、大剂量静脉注射丙种球蛋白(IVIG)或大剂量甲基强的松龙(甲强龙)、或二者联合治疗重症特发性血小板减少性紫癜(ITP)的效果。方法根据病情和病人经济能力将118例次病人分为常规剂量的强的松加输注浓缩血小板组(简称血小板组)37例;用大剂量IVIG/甲强龙组(简称药物组)39例;大剂量IVIG/甲强龙联合输注浓缩血小板组(简称联合组)42例。比较3组治疗前、后血小板计数。同时观察临床出血情况。结果治疗后外周血小板计数,血小板组升高(15.40±12.14)×109/L(p<0.001),药物组升高(17.98±14.01)×109/L(p<0.001),联合组升高(43.26±13.20)×109/L,(p<0.001)。联合组高于血小板组和药物组(p<0.001)。治疗3天后临床出血改善率,血小板组60%(22/37),药物组54%(21/39),联合组90%(38/42)。5例发热病人输注浓缩血小板后外周血小板计数未见升高。结论重症ITP病人,大剂量IVIG/甲强龙联合输注浓缩血小板较单纯输注浓缩血小板或大剂量IVIG/甲强龙疗效好,手工采和机单采浓缩血小板的输注无效性的发生率尚待进一步观察。     

特发性血小板减少性紫癜的脾切除治疗

Internet时代，随着网络的发展，医院网站建设越来越受到医院管理者的认可和重视，但如何建立网站以及建立后如何维护发展成为摆在医院网站管理者面前的问题。本文就7年来在天津市眼科医院网站建设、发展、维护工作中取得的经验进行归纳分析，对医院网站的结构、建设、更新维护、推广等几个重要方面加以总结，供同行及对医院网站感兴趣的读者参考讨论。     

特发性血小板减少性紫癜发病机制的研究进展

特发性血小板减少性紫癜是一种常见的出血性自身免疫性疾病，它的发病机制错综复杂，目前尚未完全明确。近年来，由于分子免疫学、细胞生物学以及分子遗传学的快速发展，ITP的发病机制也取得了很多新进展。本文将从血小板免疫、分子模拟、基因调控失衡、Fas／FasL凋亡途径缺陷、Fcγ受体、HLA遗传多态性、细胞因子多态性、Th1／Th2类细胞漂移、自身T细胞功能缺陷等多个角度，对ITP的发病机制作一综述。     

42例特发性血小板减少性紫癜临床分析

目的 总结近年来特发性血小板减少性紫癜的临床特点。方法 对2001年10月～2004年10月我院儿科40例特发性血小板减少性紫癜的病人临床资料进行回顾性分析。结果 42例病人中，急性型32例，慢性型10例，重症病人14例，其中合并病毒感染29例，CVB病毒（＋）8例，CMV（＋）8例，EBV（＋）5例，乙肝病毒（＋）3例，流行性腮腺炎病毒（＋）3例。结论 ITP自身免疫性疾病，与病毒感染有关，临床上急、重症病人增多，且易复发，应加强对本病的重视。     

特发性血小板减少性紫癜动物模型建立的研究进展

特发性血小板减少性紫癜(ITP)是常见的免疫性疾病之一,主要表现为外周血血小板计数明显减少,骨髓巨核细胞数正常或增多并伴有成熟障碍,是常见的出血性疾病.鉴于其自身免疫相关的发病特点,ITP的研究大部分建立在与疾病发病机制相似的动物模型上.因此,研究ITP模型的造模方法对ITP的诊断和治疗很有意义.     

特发性血小板减少性紫癜发病机制的研究进展

特发性血小板减少性紫癜是一种常见的出血性自身免疫性疾病,它的发病机制错综复杂,目前尚未完全明确。近年来,由于分子免疫学、细胞生物学以及分子遗传学的快速发展,ITP的发病机制也取得了很多新进展。本文将从血小板免疫、分子模拟、基因调控失衡、Fas/FasL凋亡途径缺陷、Fcγ脚受体、HLA遗传多态性、细胞因子多态性、Th1/Th2类细胞漂移、自身T细胞功能缺陷等多个角度,对ITP的发病机制作一综述。     

难治性特发性血小板减少性紫癜的治疗进展

特发性血小板减少性紫癜经脾切除和糖皮质激素治疗后仍需积极治疗定义为难治性特发性血小板减少性紫癜。目前糖皮质激素、免疫球蛋白、艾曲波帕 、罗米司亭、利妥昔单等已广泛应用于该病的治疗,但部分患者仍无疗效,进而有更多新型药物正在研发,如新型促血小板药物Avatrombopag（E5501）、抗CD20单克隆抗体（Veltuzumab）、Syk抑制剂（R788）、抗CD152抗体（Alemtuzumab）等,或者免疫抑制剂用于该病,如长春花碱、环孢素A、环磷酰胺等。也有针对于该病的新理论的提出需要临床验证。本文就围绕该病的治疗进展展开讨论。     

特发性血小板减少性紫癜共刺激分子表达的研究进展

特发性血小板减少性紫癜（ITP）是一种自身免疫性疾病,其发病机制尚未完全明确,目前已证实,ITP患者体内存在T、B淋巴细胞的异常活化和B淋巴细胞依赖Th细胞辅助而产生自身抗血小板抗体。在T、B淋巴细胞相互作用和产生自身抗体的病理过程中,CD80、CD86与其配体CD28、CTLA4结合及CD40与其配体CD40L相互作用提供的共刺激信号起了重要的作用。研究表明共刺激分子过度表达有可能激活自身反应性T淋巴细胞,导致自身免疫病的发生。     

丙种球蛋白治疗小儿急性特发性血小板减少性紫癜临床观察

目的 观察静脉注射大剂量丙种球蛋白(IVIg)治疗小儿急性特发性血小板减少性紫癜(ITP)疗效.方法 对我院2005年1月～2010年1月收治的小儿急性特发性血小板减少性紫癜54例患者随机分为两组,静脉注射大剂量丙种球蛋白组28例,予丙种球蛋白静脉注射0.4g/(kg.d),连用5天,之后每月静脉注射一天,连用4月;糖皮质激素治疗组26例,予静脉注射地塞米松0.5mg/(kg·d),连用5天,之后改为泼尼松每日1mg/kg口服,并逐渐减量至口服4～6周后停药.观察两组治疗效果.结果 大剂量丙种球蛋白静脉注射治疗组血小板开始上升时间为2.25±1.23天,上升至正常时间为4.75±1.35天,出血控制时间为2.75±1.25天,激素治疗组分别为8.75±3.25天、13.25±5.52天、10.4±4.25天,两组有显著差异(P<0.01).大剂量丙种球蛋白静脉注射治疗组总有效率为96.5%,激素组为80.7%,两组有明显差异(P<0.05).结论 大剂量丙种球蛋白静脉注射治疗小儿急性ITP时间短、起效快,有效率高,可降低ITP急性期大出血的危险性.     

Dose-response relationship in the treatment of idiopathic thrombocytopenic purpura with intravenous immunoglobulin

Summary The dose-response relationship in the intravenous immunoglobulin treatment of idiopathic thrombocytopenic purpura was studied in 20 adult patients in a multicenter prospective crossover trial. The rate of response increases from 3 out of 11 (27%) to 6 out of 10 treatment periods (60%) by raising the 7S-IgG dose given on 5 consecutive days from 164.50±24.55 to 359.65±58.62 mg/kg body weight. The onset and duration of response as well as the peak platelet count were found to be independent of the doses. A long-term benefit induced by intravenous immunoglobulin treatment could be achieved in 2 out of 14 patients with chronic idiopathic thrombocytopenic purpura.Abbreviations IgG Immunoglobulin G - ITP Idiopathic thrombocytopenic purpura     

特发性血小板减少性紫癜患者T细胞及B细胞亚群变化的研究

目的 探讨特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)患者T、B淋巴细胞亚群的变化.方法 从大理州人民医院收集ITP患者和健康者的外周血,用Sysmex血液分析仪及流式细胞术分析T细胞及B细胞亚群.结果 与健康人群比较,ITP患者CD3+T细胞百分率无明显变化,CD4+T细胞百分率降低(42.39％±12.12％,P＜0.05),CD8+T细胞百分率升高(46.93％±11.99％,P＜0.05);CD19+B细胞百分率升高(14.11％±10.28％,P＜0.05),T2B细胞百分率(34.51％±9,70％,P＜0.05)、成熟B细胞百分率(30.91％±7.12％,P＜0.05)及记忆性B细胞百分率(23.31％±8.23％,P＜0.05)增多,差异均有统计学意义.ITP患者T1 B细胞、Kappa+B细胞、Lambda+B细胞百分率与健康人差异无统计学意义.结论 ITP患者外周血T细胞亚群和B细胞亚群分布发生了变化,这种变化在ITP发病中的作用尚需进一步研究.     

特发性血小板减少性紫癜淋巴细胞凋亡及凋亡蛋白表达的研究

目的 :探讨淋巴细胞凋亡及凋亡蛋白表达的变化与特发性血小板减少性紫癜 (ITP)的关系。方法 :采用流式细胞仪检测 2 5例ITP患儿治疗前后外周血淋巴细胞凋亡率和Fas、FasL蛋白表达 ;采用酶联免疫夹心法 (ELISA)测定ITP患儿血清sFas、sFasL的水平。结果 :治疗后血小板恢复正常的患儿淋巴细胞凋亡率 (3 35± 1 4 3)、Fas(32 17± 6 5 4 )和FasL(41 14±6 76 )蛋白表达增加 ,与正常对照组 (0 85± 0 15、2 2 0 4± 4 5 4、2 0 83± 3 75 )和治疗前 (0 92± 0 17、2 3 0 3± 5 95、18 88± 4 5 7)相比差异有显著性意义 (P <0 0 0 1) ;治疗前ITP患者血清sFas含量为 15 5 4± 5 2 6 ,sFasL含量为 0 6 8± 0 2 3,均显著高于正常对照 (5 92± 1 78、0 33± 0 11,P <0 0 0 1)和治疗后组 (6 3± 1 92、0 36± 0 12 ,P <0 0 0 1)。结论 :ITP患者治疗后淋巴细胞凋亡增加可能与其治疗转归有关 ,sFas、sFasL的异常可能参与了ITP的免疫病理过程。     

BAFF and BAFF-R of peripheral blood and spleen mononuclear cells in idiopathic thrombocytopenic purpura

BAFF (B-cell activating factor belonging to the TNF family) is an essential component of B-cell homeostasis, and is required for the normal survival and development of B cells. To further explore the role of this cytokine in the pathogenesis of idiopathic thrombocytopenic purpura (ITP), BAFF/BAFF-R (one of receptors of BAFF) expression levels were determined and the correlation between the clinical parameters and the BAFF expression levels was analyzed. A total of 57 patients with ITP were enrolled and 25 age and sex-matched healthy volunteers served as controls. Serum was obtained from 41 patients with ITP and 22 healthy volunteers and was analyzed with a commercial human soluble BAFF (sBAFF) ELISA kit. BAFF and BAFF-R mRNA expression of peripheral blood (PB) (n = 42) and splenocytes (SP) (n = 8) mononuclear cells (MNC) were determined by real-time quantitative PCR. The SPMNC of normal controls came from three hereditary spherocytosis patients who underwent splenectomy. The untreated patients with ITP had higher serum BAFF levels (Median 1430 pg/ml, Range: 534–5787 pg/ml) than those of normal controls (Median 1120 pg/ml, Range: 640–2376 pg/ml, p = 0.006) and treated ITP group (Median 662 pg/ml, Range 267–1265 pg/ml, p = 0.000). On the other hand, serum BAFF levels of treated patients with ITP were lower than those of normal controls (p = 0.001). There was a weak correlation (the Pearson correlation coefficient is ? 0.242) between platelet count and BAFF (p = 0.064). However, BAFF levels did not correlate with platelet associated immunoglobulin or immunoglobulin levels. Moreover, the serum BAFF levels were not statistically different between acute and chronic ITP (p = 0.841). PBMNC of ITP had higher BAFF but not BAFF-R mRNA expression than that of normal controls. BAFF mRNA expression of SPMNC had a positive correlation with BAFF-R in ITP patients but not in PBMNC of normal controls and untreated ITP patients. The BAFF-R mRNA expression of SPMNC was shown to be 15.29 times higher than that of PBMNC in ITP. BAFF might contribute to autoimmunity and disease development in ITP. However, BAFF serum level must be carefully considered as a surrogate marker of disease activity in ITP.     

间充质干细胞体外对ITP患者T淋巴细胞分泌功能的影响

目的： 体外观察间充质干细胞（MSCs）对特发性血小板减少性紫癜（ITP）患者T淋巴细胞分泌细胞因子功能的影响。方法: 采用Ficoll分离和体外贴壁、传代培养,扩增出骨髓MSCs;通过Ficoll分离法和尼龙棉柱法获取ITP患者外周血T淋巴细胞。以经丝裂霉素（MMC）处理后不同数量（2×103、1×104、5×104 cells/well）的MSCs作为基底层细胞,接种体外分离纯化的异体ITP患者T淋巴细胞,分别于2 d、4 d、6 d后各自收集培养上清,用酶联免疫吸附试验(ELISA)法动态测定T淋巴细胞分泌白细胞介素2(IL-2)、干扰素-γ(IFN-γ)、白细胞介素4(IL-4)、白细胞介素10(IL-10)水平的变化。结果: ITP患者T淋巴细胞分泌细胞因子IL-2、IFN-γ较正常人高(P<0.05),IL-4、IL-10较正常人低(P<0.05)。MSCs可显著抑制ITP患者或正常对照组T淋巴细胞分泌IL-2、IFN-γ(P<0.05),且随MSCs数量的增加,抑制增强(P<0.05),共培养4 d、6 d时作用明显强于2 d时(P<0.05);MSCs可促进ITP患者T淋巴细胞分泌IL-4、IL-10 (P<0.05),且随MSCs量的增加,促进作用增强(P<0.05),对IL-10的作用随时间延长而增强(P<0.05),但对IL-4的作用在培养第2 d、4 d、6 d时无显著差异(P>0.05);在正常对照组,当MSCs数量>1×104可以促进T淋巴细胞分泌IL-4 与IL-10 (P<0.05),且随MSCs数量的增加,作用增强(P<0.05),共培养4 d、6 d时作用明显强于2 d时(P<0.05)。结论: MSCs能够在体外调节ITP患者辅助性T细胞1 (Thl)和辅助性T细胞2 (Th2)反应平衡,可使ITP患者Th1极化状态部分改善。     

Perisinusoidal fibrosis of the liver in patients with thrombocytopenic purpura

Summary 10 patients with thrombocytopenic purpura (TP) underwent splenectomy. Eight of these patients had idiopathic TP (certain or probable). All had normal liver function tests. Liver histology of the surgical biopsy was normal with the exception of a non specific mild portal infiltration in 6 cases. On Sirius red staining the perisinusoidal network was normal in 3 cases, mildly or moderately increased in 5 cases and often associated with perivenular fibrosis. Collagen types I, III, IV, laminin and fibronectin were increased in the 8 biopsies tested. On semi-thin sections, numerous Kupffer cells were observed. Under the electron microscope, sinusoidal abnormalities were very similar in all 7 patients studied: numerous Kupffer cells containing abundant lysosomes, numerous collagen bundles in the Disse space, active endothelial cells, transformation of some perisinusoidal cells into cells with some of the characteristics of fibroblasts (increased RER) and myofibroblasts (peripheral condensations of the filamentous network), increased fragments of basement membrane-like material. In two cases there was an increase in the number of perisinusoidal cells loaded with lipids. The similarity of the lesions and the absence of other fibrogenic causes (except in 2 cases) suggest that TP may represent another group of diseases with perisinusoidal fibrosis. The aetiology of fibrosis remains unknown but platelet derived growth factor and activated macrophages may play a major role.     

特发性血小板减少性紫癜患者协同刺激分子的表达

目的：探讨特发性血小板减少性紫癜（ITP）患者外周血淋巴细胞CD80、CD86及其配体CD28的表达情况。方法：应用免疫荧光标记和流式细胞技术检测34例ITP患者和34名正常人外周血淋巴细胞协同刺激分子CD80、CD86及其配体CD28的表达。结果：ITP患者外周血淋巴细胞CD80、CD86表达率（4.21±2.27%,7.19±5.16%）均明显高于正常对照组（2.34±0.87%,4.08±1.96%,p〈0.01）。结论：ITP患者CD28/CD80和CD28/CD86协同刺激分子过度表达,协同刺激分子CD80、CD86与ITP发病密切相关。     

近年血小板减少性紫癜文献分析

本文通过对1995-2003年有关血小板减少性紫癜文献年代分布、期刊分布、著者、文献主题词分布等方面进行统计分析,寻找其研究热点和发展趋势,为临床研究及治疗提供借鉴。