益气养阴健脾清热组方治疗慢性免疫性血小板减少症的疗效分析

发布时间：2018-01-08 04:02

本文关键词：益气养阴健脾清热组方治疗慢性免疫性血小板减少症的疗效分析　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨益气养阴健脾清热组方治疗慢性免疫性血小板减少症(Chronic Immune Thrombocytopenia,cITP)的疗效分析。方法:临床纳入了 2015.12-2016.12期间来自江苏省中医院血液科病房及血液科专科门诊的72例cITP患者。72例患者中儿童组30例,中药组15例,中西医组15例;成人组42例,中药组24例,中西医组18例。中药组予益气养阴健脾清热组方(炙黄芪15g、熟地黄15g、水牛角15g先煎、仙鹤草15g、肿节风15g、羊蹄根15g、蒲黄炭15g、三七粉3g冲服、茯苓15g、焦白术15g、知母10g、连翘10g、炙升麻6g),就诊时正在服用糖皮质激素者和既往使用糖皮质激素治疗有效者可继续规范用药并根据病情缓解情况逐渐撤减糖皮质激素用量。以4周为1疗程,观察至少3个疗程,比较各组每疗程治疗前后血小板计数、临床治疗总反应率、糖皮质激素撤减剂量。结果:儿童组30例患者,15例中药组患者治疗3疗程后临床治疗总反应率为86.67%,血小板计数由治疗前(29.40±20.22)×109/L升至(59.33±38.31)×109/L。3疗程后15例中西医组患者临床治疗总有效率为80.00%,血小板计数由治疗前(39.60±29.09)×109/L升至(67.67±29.34)×109/L。两组内3疗程血小板计数均较治疗前有显著性提高,差异均有统计学意义(P0.05),两组间3疗程临床治疗总反应率均无差异(P0.05)。成人组42例患者,24例中药组患者在治疗3疗程后临床治疗总有效率87.50%,血小板计数由治疗前(23.96±15.21)×109/L升至(48.67±23.03)×109/L。3疗程后18例中西医组患者临床治疗总有效率为83.33%,血小板计数由治疗前(44.72±29.81)×109/L升至(77.28±45.04)×109/L。两组内3疗程血小板计数均较治疗前有显著性提高,差异均有统计学意义(P0.05),两组间3疗程临床治疗总反应率无差异(P0.05)。全部中药组共39例患者,治疗3疗程后临床治疗总反应率87.18%,血小板计数由治疗前(26.05±17.26)×109/L升至(52.77±29.77)×109/L。全部中西医组33例患者3疗程后临床治疗总反应率为 81.82%,血小板计数由治疗前(42.39±29.14)×109/L 升至(72.91±38.44)×109/L。两组内3疗程血小板计数均较治疗前有显著性提高,差异均有统计学意义(P0.05),两组间3疗程临床治疗总反应率均无差异(P0.05)。儿童中西医组糖皮质激素剂量由治疗前10.42±5.54mg减至3.17±3.12mg,成人中西医组糖皮质激素剂量由治疗前18.12±17.37mg减至4.38±3.44mg,全部中西医组糖皮质激素剂量由治疗前14.62±13.75mg减至3.83±3.31mg,三组激素变化水平均较治疗前有显著性降低,差异有统计学意义(P0.05)。结论:本次研究结果证明益气养阴健脾清热组方具有良好的临床疗效,可以有效提高儿童及成人cITP患者血小板计数及临床治疗总反应率,并协助激素撤减,改善出血症状。
[Abstract]:Objective: To investigate the effect of Jianpi Qingre Yiqi Yangyin prescription in treatment of chronic immune thrombocytopenia (Chronic Immune, Thrombocytopenia, cITP). Methods: clinical efficacy analysis included 2015.12-2016.12 from Jiangsu Province Traditional Chinese Medicine Hospital Department of Hematology and Department of hematology ward during the clinic of 72 cases of patients with cITP.72 patients in children group 30 cases, 15 cases of Chinese medicine group, 15 cases in the group of Chinese and Western adult medicine; group 42 cases, 24 cases of Chinese medicine group, 18 cases in the group of traditional Chinese medicine and Western medicine. Chinese medicine group were treated with Yiqi Yangyin prescription Jianpi Qingre (Radix Astragali 15g, Radix Rehmanniae 15g, water buffalo 15g decocted, agrimony 15g, swelling wind 15g, Bauhinia root 15g, 15g powder 3G 37 pollen Typhae Carbonisatus, Chongbo, Fuling 15g 15g 10g, coke Atractylodes, Rhizoma Anemarrhenae, forsythia 10g, 6g), foreman cohosh treatment when taking glucocorticoids and previous use of glucocorticoid therapy can effectively continue to regulate drug according to the remission of glucocorticoid with reduced gradually. . 4 weeks as 1 course of treatment, observation of at least 3 cycles were compared before and after each course of treatment of platelet count, the total reaction rate of clinical treatment, glucocorticoid withdrawal dose. Results: 30 cases of children group, 15 cases of Chinese medicine group after 3 courses of treatment the total response rate was 86.67% for clinical treatment, platelet count from before treatment (29.40 + 20.22) * 109/L to (59.33 + 38.31) * 109/L.3 after treatment of 15 cases of traditional Chinese medicine and Western medicine group clinical total effective rate was 80%, the platelet count before treatment (39.60 + 29.09) * 109/L to (67.67 + 29.34) * 109/L. two group 3 course of treatment compared with the platelet count before treatment increased significantly, there were statistically significant differences between the two groups (P0.05), the 3 course of treatment the total response rate was not significantly different (P0.05). 42 cases of adult group, 24 cases of traditional Chinese medicine in the treatment of patients after 3 courses of treatment of the total efficiency of 87.50%, the platelet count before treatment (23.96 X + 15.21) 109/L to (48.67 + 23.03) * 109/L.3 after treatment of Western medicine group of 18 patients in the clinical treatment of patients with the total effective rate was 83.33%, the platelet count before treatment (44.72 + 29.81) * 109/L to (77.28 + 45.04) * 109/L. two group 3 course of platelet count was significantly higher than before treatment significantly increased, there were statistically significant differences between the two groups (P0.05), the total reaction rate had no difference in the clinical treatment of 3 courses (P0.05). All the Chinese medicine group of 39 patients, after 3 courses of treatment, the total response rate was 87.18% for clinical treatment, the platelet count before treatment by (26.05 + 17.26) * 109/L (52.77 + 29.77) to rise * 109/L. all the traditional Chinese and Western medicine group of 33 patients after 3 courses of treatment the total reaction rate was 81.82%, the platelet count before treatment (42.39 + 29.14) * 109/L to (72.91 + 38.44) * 109/L. two group 3 course of platelet count were significantly improved, the differences were statistically significant (P0.05), Between the two groups 3 course of clinical treatment of the total reaction rate had no significant difference (P0.05). The children of Chinese and Western medicine glucocorticoid dose group from 10.42 before treatment to 3.17 + 5.54mg + 3.12mg, adult group of traditional Chinese medicine and Western medicine glucocorticoid dose from 18.12 before treatment to 4.38 + 17.37mg + 3.44mg, all the traditional Chinese medicine and Western medicine glucocorticoid group the dose from 14.62 before treatment to 3.83 + 13.75mg + 3.31mg, the hormone levels of three groups were significantly decreased, the difference was statistically significant (P0.05). Conclusion: the results of this study prove that Jianpi Qingre Yiqi Yangyin prescription has good curative effect, can effectively improve the overall response of children and adults with cITP platelet count and clinical cure rate and help improve hormone withdrawal bleeding symptoms.

【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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