發(fā)布時(shí)間：2018-04-05 06:13

  本文選題：扶正解毒方　切入點(diǎn)：原發(fā)免疫性血小板減少癥　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的觀察扶正解毒方治療兒童原發(fā)免疫性血小板減少癥(immune thrombocytopenia,ITP)的臨床療效,并以血栓彈力圖(Thrombelastography,TEG)為切入點(diǎn),從凝血機(jī)制角度出發(fā),探索扶正解毒方對(duì)ITP患兒血小板功能的影響。方法將就診于北京中醫(yī)藥大學(xué)東直門醫(yī)院兒科門診符合納入標(biāo)準(zhǔn)的30例持續(xù)性、慢性ITP患兒,隨機(jī)分為兩組,治療組15例,予扶正解毒方聯(lián)合小劑量醋酸潑尼松治療;對(duì)照組15例,予中藥模擬劑聯(lián)合小劑量醋酸潑尼松治療;療程3個(gè)月。比較兩組PLT變化,評(píng)價(jià)扶正解毒方治療兒童ITP在1、2、3個(gè)月時(shí)的臨床療效;比較兩組的中醫(yī)證候積分、ITP出血分級(jí)量表,評(píng)價(jià)扶正解毒方對(duì)ITP兒童患者中醫(yī)證候、出血情況的改善。應(yīng)用血栓彈力圖,比較治療3個(gè)月兩組前后血栓彈力圖R、K、Angle、MA、LY30、CI數(shù)值的變化,探索扶正解毒方對(duì)患兒血小板功能的影響。結(jié)果治療組和對(duì)照組各脫落1例,共完成28例,每組各14例。1.扶正解毒方治療兒童原發(fā)免疫性血小板減少癥療效確切,治療1、2、3個(gè)月,治療組總有效率分別是35.7%、42.9%、64.3%,對(duì)照組總有效率14.3%、14.3%、28.6%。其中治療3個(gè)月時(shí)治療組的總有效率為64.3%,包括完全反應(yīng)率42.9%、有效率21.4%,高于對(duì)照組,有顯著統(tǒng)計(jì)學(xué)差異(P＜0.01);部分患兒完成了隨訪,治療組總有效率75%,對(duì)照組 50%。2.研究發(fā)現(xiàn)ITP患兒絕大多數(shù)存在血小板功能偏低(MA值低于正常),治療3個(gè)月后,比較兩組血栓彈力圖中R、K、Angle、MA、LY30、CI數(shù)值,兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);重點(diǎn)對(duì)MA值進(jìn)行自身前后比較,治療組與對(duì)照組自身前后比較MA值差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.扶正解毒方改善ITP患兒的臨床癥狀,治療組中醫(yī)證候積分總有效率78.6%,高于對(duì)照組35.7%,與對(duì)照組比較,差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05);比較治療3個(gè)月后兩組主證、次證的積分變化,患兒紫斑出血、神疲乏力、氣短、口干、便溏、自汗癥狀積分均低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。4.扶正解毒方能明顯改善ITP患兒皮膚粘膜的出血情況,治療后ITP出血分級(jí)不同程度的改善。5.扶正解毒方臨床應(yīng)用安全性高,ITP患兒治療前后安全性指標(biāo)未見明顯異常,無(wú)不良反應(yīng)發(fā)生。結(jié)論扶正解毒方治療氣不攝血型持續(xù)性、慢性ITP患兒臨床療效確切,能夠穩(wěn)定提高血小板計(jì)數(shù),改善中醫(yī)臨床癥狀及出血風(fēng)險(xiǎn),但在改善血小板功能方面不顯著。治療期間安全性指標(biāo)無(wú)明顯異常,無(wú)不良事件發(fā)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.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R272

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