探讨一线治疗失败ITP不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异

刘琪; 沈英英; 李玉珠; 王珺; 高雁婷; 沈一平; 叶宝东; 周郁鸿; 吴迪炯

doi:10.3969/j.issn.1006-2157.2023.09.020

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探讨一线治疗失败ITP不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异

血液与肿瘤 | 更新时间：2023-10-09

- 探讨一线治疗失败ITP不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异
- Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag
- 北京中医药大学学报 2023年46卷第9期页码：1325-1332
- 作者机构：
  
  1.浙江中医药大学附属第一医院(浙江省中医院)血液科　杭州　310006
  2.浙江中医药大学第一临床医学院
- 作者简介：
  
  刘琪，女，在读硕士生
  # 吴迪炯，男，副教授，副主任医师，硕士生导师，主要研究方向：中西医防治血液疾病，E-mail: wudijiong@zcmu.edu.cn
- 基金信息：
  
  国家自然科学基金项目(81603573);浙江省医学会临床医学科研专项(2022ZYC-Z25);浙江省中医药优秀青年人才基金计划(2015ZQ012);浙江名老中医专家传承工作室建设项目(GZS2021022)
- DOI：10.3969/j.issn.1006-2157.2023.09.020
  中图分类号： R255.7
- 纸质出版日期：2023-09-30，
  
  网络出版日期：2023-07-10，
  
  收稿日期：2023-03-12，
- 稿件说明：
移动端阅览
刘琪, 沈英英, 李玉珠, 等. 探讨一线治疗失败ITP不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异[J]. 北京中医药大学学报, 2023,46(9):1325-1332.

LIU Qi, SHEN Yingying, LI Yuzhu, et al. Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(9):1325-1332.
刘琪, 沈英英, 李玉珠, 等. 探讨一线治疗失败ITP不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异[J]. 北京中医药大学学报, 2023,46(9):1325-1332. DOI： 10.3969/j.issn.1006-2157.2023.09.020.

LIU Qi, SHEN Yingying, LI Yuzhu, et al. Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag[J]. Journal of Beijing University of Traditional Chinese Medicine, 2023,46(9):1325-1332. DOI： 10.3969/j.issn.1006-2157.2023.09.020.

摘要

目的

研究一线治疗失败的原发免疫性血小板减少症(ITP)不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异。

方法

收集2018年1月—2021年9月在浙江中医药大学附属第一医院血液科就诊的一线治疗失败后接受艾曲泊帕治疗的ITP患者。共纳入58例患者，按中医证候分为气不摄血证组(22例)、瘀血内阻证组(9例)、血热妄行证组(13例)和阴虚内热证组(14例)。对各组患者的免疫指标(淋巴细胞亚群、免疫球蛋白及补体)特征进行比较，并评估各组接受艾曲泊帕的疗效反应。

结果

接受艾曲泊帕治疗前，瘀血内阻证组自然杀伤细胞(NK)比例(16.91%±7.24%)及计数[(230.33±188.35)×10

－1

]均高于气不摄血证组[9.76%±6.33%，(109.38±76.60)×10

－1

]及血热妄行证组[5.82%±3.70%，(52.50±40.91)×10

－1

](均

0.05)，而各组间免疫球蛋白及补体水平比较，差异均无统计学意义。气不摄血证组、瘀血内阻证组、血热妄行证组和阴虚内热证组患者艾曲泊帕治疗总体有效率分别为68.2%(15/22)、22.2%(2/9)、61.5%(8/13)和78.6%(11/14)，其中瘀血内阻证组与阴虚内热证组、气不摄血证组疗效的差异均有统计学意义(

0.05)。

结论

患者外周血NK比例可能参与了ITP不同中医证候患者对艾曲泊帕疗效反应的差异，高NK水平在ITP瘀血内阻证患者中较为多见，预期疗效反应较低。

Abstract

Objective

We aimed to evaluate the immunological characteristics of different TCM patterns of primary immune thrombocytopenia(ITP) patients with failed first-line treatment and the response to eltrombopag.

Methods

From January

2018 to September

2021

the clinical data of 58 first-line failed ITP patients treated with eltrombopag were enrolled at First Affiliated Hospital of Zhejiang Chinese Medical University. Enrolled patients were divided into four groups based on TCM patterns

and their immune indicators

including lymphocyte subsets

immunoglobulin levels

and complement factors

with the efficacy of eltrombopag compared. Patients were classified into pattern of qi failing to control blood (22 cases)

pattern of internal blockade of static blood(9 cases)

pattern of bleeding due to blood heat(13 cases)

and pattern of endogenous heat due to yin deficiency(14 cases) group based on TCM patterns.

Results

Comparative analysis of immune indexes of ITP patients with different TCM patterns showed that the percentage and absolute count of NK cells in the pattern of internal blockade of static blood group(16.91%±7.24%

(230.33±188.35)×10

-1

) were significantly higher than those in the pattern of qi failing to control blood group(9.76%±6.33%

(109.38± 76.60)×10

-1

) and the pattern of bleeding due to blood heat group(5.82%±3.70%

(52.50±40.91)×10

-1

)(

0.05). However

there was no statistical difference in the levels of immunoglobulin and complement factors among all the groups. Comparison of the efficacy response of patients with different TCM patterns to eltrombopag showed that the effective rates in the pattern of qi failing to control blood

pattern of internal blockade of static blood

pattern of bleeding due to blood heat

and pattern of endogenous heat due to yin deficiency group were 68.2%(15/22)

22.2%(2/9)

61.5%(8/13)

and 78.6%(11/14)

respectively; the curative effect in the pattern of internal blockade of static blood group was different from that in the pattern of endogenous heat due to yin deficiency and pattern of qi failing to control blood group(

0.05).

Conclusion

The proportion of NK cells in patients’ peripheral blood may be involved in the difference of therapeutic response to eltrombopag in ITP patients with different TCM patterns. High NK cell counts are more common in ITP patients of the pattern of internal blockade of static blood group

which is related to the lower expected therapeutic response to eltrombopag.

关键词

艾曲泊帕免疫性血小板减少症瘀血内阻证淋巴细胞亚群自然杀伤细胞

Keywords

eltrombopagimmune thrombocytopeniapattern of internal blockade of static bloodlymphocyte subsetsnatural killer cells

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