Efficacy Analysis On The Treatment Of Severe Aplastic Anemia With Bushen Yisui Prescription Combined With ATG/ALG And Exploring The Pathogenesis Of Aplastic Anemia Based On T Lymphocyte Negative Selection

Objective:To analyse the clinical efficacy of Bushen Yisui Prescription in the treatment of severe chronic aplastic anemia patients combined with ATG/ALG,and to discuss some relevant clinical problems and to summarize experience.In the same time,to explore the pathogenesis of aplastic amenia based on T lymphocyte negative selection.Methods:We collected clinical data of 18 severe aplastic anemia patients who were treated by Bushen Yisui Prescription combined with ATG/ALG in the Department of Hematology,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,and retrospectively analyzed the overall efficacy,efficacy-related factors,adverse reactions, quality of life and survival status.In addition,peripheral blood samples were collected from 12 newly treated aplastic anemia patients and 12normal subjects,and the expression of Nur77 m RNA in peripheral blood mononuclear cells was detected by RT-PCR.Results:1.Overall efficacy:All 18 patients can evaluate the efficacy and the total effective rate is 66.6%(12/18).2 cases were equally cured(11.1%);1 case got remission(5.5%);9 cases got obviously improvement(50%),and 6 cases were invalid(33.3%).2.Factors related to efficacy:Patients who are 20-35 years old,;whose neutrophils are more than 0.2xl O~9/L(including 0.2xl O~9/L)before treatment;who use r-ATG;who have good response to G-CSF treatment,;whose bone marrow hematopoietic components proportion is more than 15%(including 15%);whose disease type is SAA-Ⅰ;whose TCM syndrome is kidney-yang deficiency can get higher effective rate.But due to the small sample size,only G-CSF treatment-related data have statistical significance.3.T cell subsets:CD4+,CD4/CD8+are positively correlated with the number of neutrophils before treatment,indicating that T cell subsets is related to the severity of the disease,but no exact relationship between it and efficacy has been found.4.Adverse reactions:the incidence of serosis is 22.2%(4/18);the incidence of infection is 38.8%(8/18);the incidence of blood sugar elevation is5.6%(1/18);the incidence of transaminase elevation is 16.7%(3/18).5.survival outcome:No deaths occurred during the follow-up period.12patients with therapeutic effect were detached from blood transfusion mostly in 6-12 months after treatment.4.Experimental study:The expression of Nur77 m RNA in 12 newly-treated aplastic anemia patients is slightly higher than that in the normal control group,but the difference is not statistically significant,so we presume that Nur77 is probabaly not related to the pathogenesis of aplastic anemia.Conclusion:In clinical research,Bushen Yisui Prescirption can becombined with ATG/ALG treatment,which can improve the overall efficacy,the quality of life and survival rate of patients,and reduce adverse reactions to a certain extent.In terms of experimental research,the expression of Nur77,a gene associated with negative selection of T lymphocytes,in peripheral blood mononuclear cells of newly-treated aplastic anemia patients is slightly higher than that of the normal control group,but there is no statistical difference,so it is speculated that Nur77 may not be involved in the occurrence of disease in newly-treated aplastic anemia patients.