加味归脾合剂治疗慢性免疫性血小板减少症气虚证临床研究

目的:观察加味归脾合剂治疗慢性免疫性血小板减少症(ITP)的疗效,探讨中药复方制剂对ITP患者Treg/Th17免疫紊乱调控的有效干预机制。方法:将符合标准的60例慢性ITP患者随机分为中药组和激素组各30例,中药组予加味归脾合剂治疗,激素组予泼尼松治疗,记录治疗前后ITP患者血清中细胞因子Treg细胞、Th17细胞以及Treg/Th17比值,Foxp3mRNA、RORγt mRNA、Foxp3/RORγt比值检测结果及外周血血小板计数。结果 :(1)血小板计数:中药组和激素组治疗后均有所上升,与治疗前比较差异有统计学意义(P0.01),组间比较差异无统计学意义(P0.05)。(2)Treg/Th17:中药组与激素组治疗前与正常对照组比较,Treg细胞、Th17细胞、Treg/Th17比值、Foxp3mRNA、RORγt mRNA表达、Foxp3/Ro Rγt比值差异均有统计学意义(P0.05);治疗后中药组Treg细胞表达与Treg/Th17比值、Foxp3mRNA表达、Foxp3/Ro Rγt比值检测均高于激素组,组间比较差异有统计学意义(P0.05);Th17和RORγtmRNA表达,组间比较差异无统计学意义(P0.05)。结论:加味归脾合剂可有效提升血小板计数及Treg细胞、Treg/Th17比值、Foxp3mRNA、Foxp3/Ro RγT比值,其上调Treg细胞及Foxp3mRNA表达,从而改善Treg/Th17免疫功能紊乱,健脾益气统血是治疗ITP气虚证的主要机制之一。

Clinical Study of Jiawei Guipi Mixture Treating Patients with Chronic Immune Thrombocytopenia of Qi Deficiency Syndrome

Objective:To observe the efficacy of Jiawei Guipi mixture in the treatment of chronic immune thrombocytopenia(ITP),and to explore the mechanism of this mixture on the Treg/Th17 in patients with ITP. Methods:There were 60 patients with chronic ITP meeting the inclusion criteria randomly divided into Chinese herb group and the hormone group,30 cases in each group. In the Chinese herb group,patients were given Jiawei Guipi mixture,while in the hormone group,patients were treated with prednisone. Before and after treatment,the related serum cytokines,counts of Treg cells and Th17 cells were measured and recorded as well as the ratio of Treg to Th17,Foxp3 mRNA and RORγt mRNA were measured and recorded as well as Foxp3 to RORγt,and platelet count in the peripheral blood was measured and recorded. Results:(1)Platelet count:in Chinese herb group and hormone group after treatment it increased,and it showed statistically significant(P< 0.01) compared with before treatment there were,but there was no statistically significant between the groups(P> 0.05).(2)Treg/Th17:in Chinese herb group and the hormone group before treatment compared with normal control group,Treg cells,Th17 cells,Treg/Th17 ratio,Foxp3 mRNA,expression of RORγt mRNA,Foxp3/RORγt ratio showed statistically significant(P< 0.05);in Chinese herb group after treatment,the expression of Treg cells,Treg/Th17 ratio,the expression of Foxp3 mRNA,and Foxp3/RORγt ratio were significantly higher than those in hormone group,with statistically significant between the groups(P< 0.05);expression of Th17 and RORγt mRNA showed no statistically significant between the Chinese herb group and hormone group(P> 0.05). Conclusions:Jiawei Guipi mixture can effectively improve the counts of platelet and Treg cells,Treg/Th17 ratio,Foxp3 mRNA,Foxp3/RORγt ratio,and can upregulate Treg cells and expression of Foxp3 mRNA,thereby relieving the immune dysfunction of Treg/Th17,which could be the major mechanism of using methods of invigorating spleen,tonifying qi and governing blood to treat chronic ITP.