CAJ | 학술논문

目的：探讨重组人血小板生成素联合中药辨证治疗老年难治性原发免疫性血小板减少症的临床疗效。方法选择老年难治性原发免疫性血小板减少症患者43例，随机分为治疗组和对照组，对照组患者给予标准剂量重组人血小板生成素（rhTPO，300 IU／kg ，剂型15000 IU／支）治疗，治疗组（20例）又分为3型，在标准剂量rhTPO 应用基础上，加中药辩证治疗，随访时间为2个月，比较两组及治疗组3型治疗后血小板水平、疗效、出血部位和维持缓解情况等相关指标的变化。结果（1）两组患者治疗14 d 后血小板（PLT）＞20×109个／L 者比例分别为85．00％（17／20）及73．91％（17／23），差异无统计学意义（P ＞0．05）；（2）治疗组总有效率为60．00％，对照组总有效率为30．43％，差异有统计学意义（P ＜0．05）；治疗组中气不摄血型有效率优于其他证型，差异有统计学意义（P ＜0．05）；（3）治疗组治疗有效患者中12例后续维持 PLT＞20×109个／L，对照组治疗有效患者中7例后续维持PLT＞20×109个／L，差异有统计学意义（P ＜0．05），治疗组3型疗效比较差异有统计学意义。（4）治疗组与对照组出血情况（部位）比较差异有统计学意义（P ＜0．05）；治疗组不同证型出血情况（部位）比较差异有统计学意义（P ＜0．05）。结论rhTPO 联合中药辨证治疗老年难治性原发免疫性血小板减少症的疗效优于单纯采用 rhTPO治疗。
목적：탐토중조인혈소판생성소연합중약변증치료노년난치성원발면역성혈소판감소증적림상료효。방법선택노년난치성원발면역성혈소판감소증환자43례，수궤분위치료조화대조조，대조조환자급여표준제량중조인혈소판생성소（rhTPO，300 IU／kg ，제형15000 IU／지）치료，치료조（20례）우분위3형，재표준제량rhTPO 응용기출상，가중약변증치료，수방시간위2개월，비교량조급치료조3형치료후혈소판수평、료효、출혈부위화유지완해정황등상관지표적변화。결과（1）량조환자치료14 d 후혈소판（PLT）＞20×109개／L 자비례분별위85．00％（17／20）급73．91％（17／23），차이무통계학의의（P ＞0．05）；（2）치료조총유효솔위60．00％，대조조총유효솔위30．43％，차이유통계학의의（P ＜0．05）；치료조중기불섭혈형유효솔우우기타증형，차이유통계학의의（P ＜0．05）；（3）치료조치료유효환자중12례후속유지 PLT＞20×109개／L，대조조치료유효환자중7례후속유지PLT＞20×109개／L，차이유통계학의의（P ＜0．05），치료조3형료효비교차이유통계학의의。（4）치료조여대조조출혈정황（부위）비교차이유통계학의의（P ＜0．05）；치료조불동증형출혈정황（부위）비교차이유통계학의의（P ＜0．05）。결론rhTPO 연합중약변증치료노년난치성원발면역성혈소판감소증적료효우우단순채용 rhTPO치료。
Objective To observe the therapeutic effect on old refractory idiopathic throm-bocytopenic pur-pura by means of recombinant human thrombopoietin (rhTPO)combined with traditional Chinese medi-cine.Methods 43 cases of old patients with rITP were randomly divided into two groups:20 patients in treatment group,with orally rhTPO combined with Chinese traditional medicine;23 patients in the control group,with rhTPO.The therapeutic course lasted for 2 months.The platelet count level,the bleeding site and the maintenance of remission were observed before and after treatment and clinical effica-cy of the treatment was compared and evaluated.Results (1)The effect rate of PLT>20×10 9 for 14days treatment was 85% in the treatment group and 73.91% in the control group respectively,without signifi-cant diffidence in two groups (P >0.05);(2)The total effective rate was 60% in the treatment group and 30.43% in the control group respectively,with significant diffidence in two groups (P <0.05);The total effective rate showed significant diffidence in three different TCM types in the treatment group (P <0.05),with superior effect in the type of Qi failing to control blood to the others types;(3)The improve-ment of the hemorrhage and maintained remission in the treated group were superior to those in the control group (P <0.05),with significant diffidence in three different TCM types in the treatment group (P <0.05),with superior effect in type of Qi failing to control blood to the others;(4)It proved that the effica-cy had a positive correlation with the number of megakaryocyte.Conclusion It proved that the therapy of rhTPO combined with Chinese traditional medicine had a superior clinic efficacy to rhTPO therapy on old refractory idiopathic throm-bocytopenic purpura,with the improvement in the level of peripheral blood platelet in a short time,effective control of bleeding symptoms and prolonged maintain remission.