补肾益髓法对地中海贫血患者β-珠蛋白及BCL11A基因表达的影响

目的:探讨补肾益髓法对地中海贫血患者β-珠蛋白基因的调控作用及B细胞淋巴瘤11A蛋白(B-cell lymphoma11A,BCL 11A)基因表达影响。方法:将82例患者随机分为对照组和治疗组,每组41例。对照组口服羟基脲片治疗,每日25 mg·kg~(-1),每周2次,6周为1个疗程,连续治疗2个疗程。治疗组:在对照组的治疗基础上,配合应用补肾益髓法治疗,方药组成:山萸肉、何首乌、熟地黄、补骨脂、黄芪、鳖甲、甘草。各每袋10 g,生药量相当于2.27 g中药原材,由中国中医科学院广安门医院大兴制剂中心生产,每日1袋,每日3次,温开水冲服,连续治疗3个月。观察两组患者治疗前后血常规、β珠蛋白基因mRNA(β-mRNA)、γ珠蛋白基因mRNA(γ-mRNA)、BCL 11A水平变化情况,并比较两组患者的临床疗效。结果:与治疗前比较,两组患者血红蛋白(hemoglobin,Hb)、红细胞总数(red blood cel,RBC)、网织红细胞(reticulocyte,Ret)、红细胞平均体积(erythrocyte mean corpuscular,MCV)、γ-mRNA及γ/(γ+β)mRNA水平均较治疗前明显升高,差异有统计学意义(P0.05);BCL 11A及中医证候评分均较治疗前明显降低,差异有统计学意义(P0.05);与对照组比较,治疗组患者治疗后Hb、RBC、Ret、MCV、γmRNA、γ/(γ+β)mRNA表达水平改善情况及治疗有效率高于对照组,差异有统计学意义(P0.05);BCL 11A水平及中医证候评分均低于对照组,差异有统计学意义(P0.05),两组之间及治疗前后β-mRNA水平比较,差异均无统计学意义(P0.05);两组不良反应比较,差异无统计学意义(P0.05)。结论:补肾益髓法能有效降低地中海贫血患者BCL 11A表达水平,提高Hb、WBC、Ret和γ-mRNA表达水平,具有较好的临床疗效,安全性良好,但对β-mRNA水平无明显影响,其具体作用机制有待于进一步研究。

Influence on the Beta Globin and BCL11A Gene Expression by Method of Invigorating Kidney and Benefiting Marrow in Patients with Mediterranean Anemia

Objective:To investigate the effect of the Beta globin regulation effect and BCL11A gene expression by method of invigorating kidney and benefiting marrow in patients with Mediterranean anemia.Methods:82 patients were selected and randomly divided into two groups.41 cases in the control group were treated by clinical routine treatment,41 cases in the experiment group were treated on the base of the control group with method of invigorating kidney and benefiting marrow.Composition:Fructus Corni,Radix Polygoni Multiflori,Radix Rehmanniae Preparata,Fructus Psoraleae,Astragalus,Turtle Shell,Licorice.Each bag is 10 g,equivalent to 2.27 g crude drug Chinese medicinc raw material,by Daxing preparation center of Guang'anmen Hospital of China Academy of Chinese Medical Science,1 bag per day,3 times a day,warm boiling water,for 3 months.The change of blood routine,β-mRNA,γ-mRNA,BCL11A levels and clinical efficacy in two groups before and after treatment were observed.Results:Compared with before treatment,two groups of patients with hemoglobin (Hb),red blood cell (RBC),reticulocyte (Ret),erythrocyte mean corpuscular(MCV),γ-mRNA and γ/(γ+ β) mRNA levels were significantly higher than before treatment (P ＜ 0.05),BCL11A and TCM symptom scores were significantly lower than before treatment(P ＜ 0.05).Comnpared with the control group,the experimental group of patients after treatment of Hb,RBC,Ret,MCV,γ-mRNA,γ/(γ + β) mRNA and effective rate of treatment was higher than the control group,the level of BCL11A and symptom scores were lower than the control group;the differences were statistically significant (P ＜ 0.05).There was no significant difference in the level of β-mRNA between the two groups before and after treatment (P ＞ 0.05).Conclusion:Method of invigorating kidney and benefiting marrow can effectively reduce the expression level of BCL11A in patients with thalassemia,,and improve Hb,WBC,Ret and γ-mRNA gene expression level,and has better clinical efficacy,good safety,but has no effect on the beta mRNA level,and the specific mechanism needs be further studied.