免疫性血小板减少性紫癜发病机制及中医研究简况

免疫性血小板减少性紫癜发病与病毒、血小板抗体、心磷脂抗体、抗巨噬细胞抗体、T细胞亚群失衡有关,治疗仍首选糖皮质激素,长期服用副作用大,减量有可能复发;脾切除有50%术后6个月内复发;免疫抑制剂应用及联合化疗亦取得一定疗效,副作用太大,与期望值相差甚远;IVIG与抗-D短期内效果显著,价格昂贵,不能作为一线药;联合化疗多为个案报导,虽有疗效但长期应用副作用大,患者难以接受;单克隆抗体开创了治疗免疫性疾病的新纪元,许多生物制剂应用,但价格昂贵远期效果不能肯定。病因病机可归纳为实热迫血妄行,或阴虚火旺;脾虚不能统血,气虚不能摄血;瘀血内阻,血不循经;在"盛"及"气伤"基础上,瘀血不去,新血不生;气为血帅,血为气母,无血则气无以化,无气则血无以生,强调肝脾肾对出血的影响。中医药能改善临床症状,减轻激素的用量及副作用,提高患者生命质量。但缺乏辨证的规范性,无论辨病或辨证,都缺乏多中心、大样本、可重复性。主要问题1辩证过程中主观性较强,至今还没有统一规范化指标,;2证型研究中"关系"或"相关性"的文章并非真正相关性研究,没有经过统计学相关性检验,只是分布规律的初步观察;3虽有指标对ITP的中医分型有一定客观反映,由于机体复杂性,只有一定的相对特异性,因而造成单一指标结论不一致;4缺乏多中心、大样本、随机化的临床实验,使一些结论可能偏差;5目前对ITP客观化研究限于单一指标,缺乏多指标的合参。

Immune Thrombocytopenic Purpura Pathogenesis Traditional Chinese Medicine Research

Immune thrombocytopenic purpura associated with virus, platelet antibody, anticardiolipin antibodies, anti macrophage antibody, T cell subsets imbalance, the treatment is still the preferred corticosteroid, long-term use oflarge side effect, reducing the possibility of a recurrence of; splenectomy 50% recurrence within 6 months after theapplication of immunosuppressant and combined chemotherapy; also have certain curative effect, side effects too, far from the expected value; IVIG and anti -D short-term effect is obvious, the price is expensive, not as the first-line drug; combined chemotherapy for case reports, although the effect but long-term side effects, patients are difficult to accept ; monoclonal antibody ushered in a new era in the treatment of autoimmune the disease, many biologicalagents, but the price is expensive long-term effectiveness is uncertain. Etiology can be summarized as the reahhermal forcing blood folly, or hyperactivity of fire due to yin deficiency ; deficiency of spleen and blood can not be unified, Qi deficiency and failure of blood ; blood stasis, blood does not follow through; in the “Sheng” and“barotrauma” basis, blood stasis does not go, new blood is not life ; Qi as the commander of blood, blood mother of Qi, no blood gas does not take, no gas, no blood to students, emphasizing the influence of liver and spleen kidneyhemorrhage. Traditional Chinese medicine can improve the clinical symptoms, reduce hormone dosage and side effects, improve patients quality of life. But the lack of standardization of syndrome differentiation, disease differentiation and syndrome differentiation of both, the lack of multi center, large sample, repeatability. The mainproblems in the process of subjective dialectics is strong, there is no uniform standard index; ②, syndrome study“relationship” or “correlation” articles are not really related research, without statistical correlation test, the preliminaryobservation of just distribution ; and though Chinese index for the classification