探讨扶正解毒方治疗儿童ITP的临床疗效及其对血小板功能的影响

发布时间：2018-04-05 06:13

本文选题：扶正解毒方　切入点：原发免疫性血小板减少症　出处：《北京中医药大学》2017年硕士论文

【摘要】：目的观察扶正解毒方治疗儿童原发免疫性血小板减少症(immune thrombocytopenia,ITP)的临床疗效,并以血栓弹力图(Thrombelastography,TEG)为切入点,从凝血机制角度出发,探索扶正解毒方对ITP患儿血小板功能的影响。方法将就诊于北京中医药大学东直门医院儿科门诊符合纳入标准的30例持续性、慢性ITP患儿,随机分为两组,治疗组15例,予扶正解毒方联合小剂量醋酸泼尼松治疗;对照组15例,予中药模拟剂联合小剂量醋酸泼尼松治疗;疗程3个月。比较两组PLT变化,评价扶正解毒方治疗儿童ITP在1、2、3个月时的临床疗效;比较两组的中医证候积分、ITP出血分级量表,评价扶正解毒方对ITP儿童患者中医证候、出血情况的改善。应用血栓弹力图,比较治疗3个月两组前后血栓弹力图R、K、Angle、MA、LY30、CI数值的变化,探索扶正解毒方对患儿血小板功能的影响。结果治疗组和对照组各脱落1例,共完成28例,每组各14例。1.扶正解毒方治疗儿童原发免疫性血小板减少症疗效确切,治疗1、2、3个月,治疗组总有效率分别是35.7%、42.9%、64.3%,对照组总有效率14.3%、14.3%、28.6%。其中治疗3个月时治疗组的总有效率为64.3%,包括完全反应率42.9%、有效率21.4%,高于对照组,有显著统计学差异(P＜0.01);部分患儿完成了随访,治疗组总有效率75%,对照组 50%。2.研究发现ITP患儿绝大多数存在血小板功能偏低(MA值低于正常),治疗3个月后,比较两组血栓弹力图中R、K、Angle、MA、LY30、CI数值,两组差异无统计学意义(P0.05);重点对MA值进行自身前后比较,治疗组与对照组自身前后比较MA值差异均无统计学意义(P0.05)。3.扶正解毒方改善ITP患儿的临床症状,治疗组中医证候积分总有效率78.6%,高于对照组35.7%,与对照组比较,差异具有统计学意义(P＜0.05);比较治疗3个月后两组主证、次证的积分变化,患儿紫斑出血、神疲乏力、气短、口干、便溏、自汗症状积分均低于对照组,差异均有统计学意义(P0.05)。4.扶正解毒方能明显改善ITP患儿皮肤粘膜的出血情况,治疗后ITP出血分级不同程度的改善。5.扶正解毒方临床应用安全性高,ITP患儿治疗前后安全性指标未见明显异常,无不良反应发生。结论扶正解毒方治疗气不摄血型持续性、慢性ITP患儿临床疗效确切,能够稳定提高血小板计数,改善中医临床症状及出血风险,但在改善血小板功能方面不显著。治疗期间安全性指标无明显异常,无不良事件发生,提示扶正解毒方安全性高。
[Abstract]:Objective to observe the clinical efficacy of Fuzheng jiedu recipe (FJD) in treating children with primary immune thrombocytopenia (ITP), and to explore the effect of Fuzheng jiedu recipe (FJD) on platelet function in children with ITP from the point of view of coagulation mechanism.Methods Thirty children with chronic ITP who were admitted to the pediatric outpatient clinic of Dongzhimen Hospital, Beijing University of traditional Chinese Medicine were randomly divided into two groups: 15 patients in the treatment group were treated with Fuzheng jiedu recipe combined with low-dose prednisone acetate;The control group (n = 15) was treated with traditional Chinese medicine mimic and low dose prednisone acetate for 3 months.To compare the changes of PLT between the two groups, to evaluate the clinical efficacy of Fuzheng jiedu recipe in the treatment of children with ITP at 1 and 3 months, to compare the TCM syndromes integral and the bleeding scale of the two groups, and to evaluate the improvement of Fuzheng jiedu recipe on TCM syndromes and bleeding in children with ITP.Thromboelastograms were used to compare the changes of thromboelastic values between the two groups before and after 3 months of treatment, and to explore the effect of Fuzheng jiedu recipe on platelet function in children.Results the treatment group and the control group each lost one case, a total of 28 cases, each group 14 cases.The curative effect of Fuzheng jiedu recipe on primary immune thrombocytopenia in children was definite. The total effective rate of the treatment group was 35.70.42. 9% and 64.3% respectively, and the total effective rate of the control group was 14.30.14.3%.The total effective rate of the treatment group was 64.3 at 3 months, including the complete reaction rate of 42.9 and the effective rate of 21.40.It was significantly higher than that of the control group (P < 0.01), some of the children were followed up, the total effective rate of the treatment group was 75g, and the control group was 50.2.The study found that most of the children with ITP had low platelet function and MA value lower than normal. After 3 months of treatment, the values of RV K Anglev MALY30 CI in thromboelastogram were compared between the two groups, and there was no significant difference between the two groups (P 0.05), and the MA value was compared before and after treatment.There was no significant difference in MA value between the treatment group and the control group before and after the comparison (P 0.05). 3.Fuzheng jiedu recipe improved the clinical symptoms of children with ITP. The total effective rate of TCM syndromes integral in the treatment group was 78.6, which was higher than that in the control group (35.75.Compared with the control group, the difference was significant (P < 0.05).The scores of purple spot hemorrhage, fatigue, shortness of breath, dry mouth, loose stool and self-sweating symptom in children were lower than those in the control group (P 0.05. 4).Fuzheng jiedu prescription can obviously improve the bleeding of skin and mucous membrane in children with ITP. After treatment, the bleeding grade of ITP can be improved by 5. 5%.The safety index of Fuzheng jiedu prescription before and after treatment was not abnormal, and no adverse reaction occurred in children with ITP.Conclusion Fuzheng jiedu recipe is effective in treating blood group persistence in children with chronic ITP. It can steadily increase platelet count, improve clinical symptoms and bleeding risk of TCM, but it is not significant in improving platelet function in children with chronic ITP.There was no obvious abnormal safety index and no adverse events during treatment, suggesting that Fuzheng jiedu prescription was safe.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R272

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