原发性血小板增多症中医证候分析及血实方干预的临床观察

发布时间：2018-11-01 13:37

【摘要】：目的:探讨原发性血小板增多症的中医证候分析、血实方干预治疗本病后的临床观察。方法:本研究选取2008年1月至2016年12月新疆自治区中医院血液科住院病人,及2014年9月至2016年12月导师专家门诊就诊ET患者,且治疗以羟基脲为基础治疗患者视为对照组,在维持羟基脲治疗基础上,给予血实方加减治疗的患者为治疗组,采用回顾性的方式研究调查,并对每位患者的临床症状、体征、实验室检查结果进一步统计分析,评估血实方治疗ET的近期疗效及作用优势。结果:1.78例ET患者,男性36例,占46.2%,女性42例,占53.8%;民族分布情况,经χ2检验,差异无统计学意义(P㧐0.05)。2.大于60岁为高发年龄段,与现有符合流行病学调查结果一致。两组无统计学差异(P㧐0.05)。3.两组凝血功能、脾脏大小、证型经χ2检验,差异均无统计学意义(均P㧐0.05);4.JAK2V617F阳性率48.7%。5.四种中医临床证型分布,依次排列为正虚血瘀寒凝血瘀气滞血瘀邪热温毒致瘀。6.PLT计数变化情况,治疗组明显低于对照组,差异有统计学意义(P㩳0.05);WBC计数、HGB变化情况,治疗组明显高于对照组,差异有统计学意义(P㩳0.05);7.在全血细胞变化中,PLT、WBC第1周明显高于第4周、8周和12周,有统计学差异(P㩳0.05);8.治疗组每个疗程HBG变化,差异无统计学意义(P㧐0.05),对照组有统计学差异(P㩳0.05);9.两组治疗前中医单项症状积分、临床症状总积分的比较,差异均无统计学意义(均P㧐0.05);治疗后,治疗组均明显低于对照组,差异有统计学意义(P㩳0.05)。10.两组患者中医证候疗效经Mann-Whitney检验结果显示,治疗组显效人数明显多于对照组,差异有统计学意义(P=0.0000.05)。11.中医证候疗效比较,显效(率%)、有效(率%)、总有效(率%)分别为:治疗组:66.67%、33.33%、100%。对照组:3.33%、80.00%、78.95%。结论:1.ET患者在年龄、性别的分布情况与国内外流行病学调查研究结果一致;2.本调查结果ET中医临床证型以正虚血瘀为多,以虚实夹杂为主。3.在西医治疗基础上,懫用血实方治疗ET疗效肯定。其既能有效降低血小板水平,同时预防白细胞及血红蛋白降低,又能有效缓解临床症状,提高改善患者生活质量。4.JAK2V617F阳性率结果符合现代医学调查结果。
[Abstract]:Objective: to explore the analysis of TCM syndromes of idiopathic thrombocytopenia and the clinical observation of Xueshifang intervention in the treatment of this disease. Methods: patients in hematology department of Xinjiang Autonomous region Hospital of traditional Chinese Medicine from January 2008 to December 2016 and ET patients from September 2014 to December 2016 were selected as control group. On the basis of maintaining the treatment of hydroxyurea, the patients who were treated with Xue Shi Fang were used as the treatment group, and the clinical symptoms, signs and laboratory results of each patient were analyzed by retrospective study, and the results of the clinical symptoms, signs and laboratory examinations were further statistically analyzed. To evaluate the short-term curative effect and effect advantage of Xue Shi Fang in treating ET. Results: 1.Seventy-eight patients with ET, 36 males (46.2%) and 42 females (53.8%), had no significant difference in ethnic distribution by 蠂 2 test (P0. 05). The high incidence age group was over 60 years old, which was consistent with the current epidemiological survey results. There was no statistical difference between the two groups (P < 0.05). There was no significant difference in coagulation function, spleen size and syndrome type between the two groups (P < 0. 05), and the positive rate of 4.JAK2V617F was 48.7. 5. The distribution of four types of TCM syndromes was arranged in order of deficiency of blood stasis, cold coagulation, blood stasis, heat and toxin. The change of 6.PLT count in the treatment group was obviously lower than that in the control group, the difference was statistically significant (P0. 05). WBC count, HGB changes, the treatment group was significantly higher than the control group, the difference was statistically significant (P0. 05); In the whole blood cell changes, PLT,WBC was significantly higher in the 1st week than in the 4th, 8th and 12th week (P0. 05). The change of HBG in each course of treatment in the treatment group was not statistically significant (P0. 05), in the control group there was a statistical difference (P0. 05); Before treatment, there was no significant difference in the scores of single symptoms and total clinical symptoms between the two groups (P0. 05), and after treatment, the scores in the treatment group were significantly lower than those in the control group (P0. 05), the difference was statistically significant (P0. 05). The results of Mann-Whitney test showed that the number of patients in the treatment group was significantly higher than that in the control group, and the difference was statistically significant (P < 0. 0000. 05). The curative effects of TCM syndromes were obviously effective (%), and total effective (%) were: treatment group: 66.67 ~ 33.33%. In the control group: 3.33 and 80.002 / 78.95. Conclusion: the distribution of age and sex in patients with 1.ET is consistent with the results of epidemiological investigation at home and abroad. 2. The results of this investigation showed that the clinical syndromes of ET were mostly positive deficiency and blood stasis, and the main types were deficiency and solid inclusion. On the basis of western medicine treatment, the curative effect of Xue Shi Fang on ET was confirmed. It can not only effectively reduce platelet level, but also prevent the decrease of white blood cell and hemoglobin, relieve clinical symptoms and improve the quality of life of patients. The results of 4.JAK2V617F positive rate accord with the results of modern medical investigation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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