| Objective:Through retrospective analysis,research on TCM syndromes of patients with ITP,explore the relationship between TCM syndromes and patients’gender,age,course of disease and bleeding,as well as changes in immunological indicators of patients with ITP.Further analyze the clinical efficacy and formulating ideas of TCM,and use animal experiments to analyze the efficacy of TCM and integrated traditional Chinese and Western medicine in the treatment of ITP,in order to further guide the TCM treatment of ITP.Methods:Study 1:Selected ITP patients who were hospitalized in the Department of Hematology,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from June2015 to October 2020,and a total of 81 patients with ITP who met the inclusion criteria were divided into four categories based on the information of the four clinics and their medications.There are three types of syndromes:yin deficiency and fire prosperous syndrome,qi deficiency inadequacy syndrome,and blood-heat disorder.Using retrospective research methods,the age,gender,course of disease,and related laboratory tests of ITP patients were collected,and 30 non-ITP personnel who had recently undergone physical examination in our hospital’s physical examination center were randomly selected as normal controls.The relationship between ITP TCM syndrome type and patient’s gender,age,course of disease,refractory,fatigue symptoms and bleeding score,as well as the differences in the overall immune results of patients with different syndrome types and non-ITP personnel were discussed.Study 2:To evaluate the efficacy of patients during their hospitalization and one year after they were discharged from the hospital,collect the treatment status of ITP patients who only use traditional Chinese medicine in the inpatient and outpatient clinics,and collect the patient’s prescriptions for traditional Chinese medicine.Assess the short-term and long-term curative effects of combined traditional Chinese and western medicine and traditional Chinese medicine alone,as well as the regularity of ITP traditional Chinese medicine treatment prescriptions.Study 3:Divide mice into traditional Chinese medicine+antibody group,hormone+antibody group,combination medication+antibody group,saline+antibody group,and saline+saline group.The ITP animal model was prepared by passive immunization.The antibody group was intraperitoneally injected with 1μg/200μL of CD41 monoclonal antibody daily for 9 days to maintain the continuous reduction of platelets.The rest were given corresponding drugs every day for 9 days.The blood routine of mice was measured at d0,2,4,and 8,respectively,to evaluate the effect of drugs on mouse platelets.Results:(1)The syndrome types of 81 patients with ITP were counted.Among them,the syndrome of yin deficiency and hyperactivity of fire was the most,66 cases in total,9 cases of deficiency of qi syndrome,and 6 cases of abnormal blood-heat syndrome.53.0%of patients with Yin deficiency and Huowang showed symptoms of fatigue.In addition,there were 15patients with hormone-dependent/refractory and 9 patients with refractory,all of which belonged to Yin deficiency and fire prosperous syndrome.Statistics on the gender and age of patients with different TCM syndromes showed no statistically significant difference(P>0.05);statistics on the course of patients with different TCM syndromes showed that patients with blood-heat delusion were mainly diagnosed with new diagnoses,with Yin deficiency and fire prosperous.The chronic phase is the main type of Qi deficiency and non-intake syndrome,and the difference is statistically significant(P<0.05).Therefore,this study believes that the distribution of TCM syndrome types is not related to the patient’s gender and age,but is related to the course of the disease.(2)The bleeding of 81 patients was evaluated,and it was found that there was no significant difference in the bleeding scores of the patients with different syndrome types(P>0.05).The patients with Yin deficiency and fire prosperous were further distinguished and found refractory patients,hormone dependence/refractory and accusation There was no statistically significant difference in the bleeding scores of the treated patients(P>0.05).Therefore,this study believes that the bleeding of patients with ITP has nothing to do with the type of syndrome.(3)Analyze all immune items(including complement C3,C4,Ig G,Ig A,Ig M)of ITP patients with different syndrome types and compare with non-ITP personnel.After statistical analysis,there are differences in the levels of complement C3,C4,and Ig M in these data(P<0.05).After further pairwise comparisons,it was found that the median level of complement C3 in patients with Yin deficiency and fire-prosperity syndrome and Qi-deficiency non-intake syndrome was lower than that of the non-ITP population,the difference was statistically significant(P<0.05);the median level of complement C4 in patients with Yin-deficiency and fire-prosperity syndrome was low There was a statistically significant difference between patients with blood-heat delusion syndrome and non-ITP groups(P<0.05);the median Ig M level in patients with blood-heat delusion syndrome was lower than that of patients with Yin deficiency and fire-prosperity syndrome,and the difference was statistically significant(P<0.05).The pairwise comparisons of the remaining groups were not statistically significant in this study(P>0.05).A further study on the differentiation of patients with Yin deficiency and hyperactivity found that the median level of complement C3 in refractory patients was lower than that in non-refractory patients,the difference was statistically significant(P<0.05),and the differences in other indicators were not statistically significant.(4)The previous treatment status of 81 patients was counted.There are various treatment methods for ITP,and some patients did not pay attention to it after they developed subcutaneous purpura.Among the 71 patients who have been treated,54(76.1%)patients have been treated with hormone therapy.Among them,10 patients(18.5%)have only used low-dose hormone therapy,and the effect is not good;19 patients(35.2%)have spontaneous Circumstances of dose reduction or withdrawal.Another 14 patients(19.7%)refused to use western medicine or refused hormone/gamma globulin therapy.Patient dependence in ITP treatment is poor.(5)Statistics of the treatment of ITP patients after admission.At the time of discharge,40of the 81 patients(49.4%)were completely effective(CR),20(24.7%)were partially effective(PR),and overall effective(OR).The rate is 74.1%.A total of 54 patients were discharged from the outpatient clinic for more than 1 year.Among them,13 patients were treated with high-dose hormones combined with traditional Chinese medicine,high-dose hormones combined with TPO and traditional Chinese medicine,and regular follow-up visits were performed for 1 year.The OR rate at discharge was 84.6%and the CR rate was 61.5%.;After1 year,the SR rate was 76.9%,and the continuous CR was 46.2%.There was no significant difference in the efficacy between before and after(P>0.05).(6)Thirty patients who used Chinese medicine alone were included.Before treatment,the average platelet value was 27.7×10~9/L,and the median level was 28.25×10~9/L;the average platelet value was 41.4×10~9/L and the median level was 42.35×10~9/L in March of treatment.;The mean platelet value was 52.2×10~9/L and the median level was 47.25×10~9/L in June.Repeated measurement analysis found that there was a difference in platelet levels before and after treatment(P<0.05),suggesting that traditional Chinese medicine treatment can improve platelet levels in some patients.(7)Statistical analysis of the ITP prescriptions.The main treatment ideas are to clear away heat,cool blood,nourish yin,replenish qi,stop bleeding and promote blood circulation.The core drugs are rehmannia,tortoise shell,madder,agrimony,arborvitae leaves,tuckahoe,zea Diarrhea,yam,codonopsis,licorice.(8)The analysis results of the platelet levels of mice in each group showed that there was no significant difference in platelet levels between the traditional Chinese medicine+antibody group and the saline+antibody group(P>0.05);the hormone+antibody group was compared with the combination medication+antibody group in the first four days of platelets The level was low,and the difference was statistically significant on the fourth day(P<0.05).Conclusion:The distribution of TCM syndrome types of ITP is not related to the patient’s gender,age,and bleeding,but is related to the course of the disease.Newly diagnosed patients are mostly with blood-heat disorder.The level of complement C3 is lower in patients with Yin-deficiency and fire-prosperity syndrome and Qi-deficiency syndrome;the level of complement C3 is lower in patients with refractory disease;the level of complement C4 is lower in patients with Yin-deficiency and fire-prosperity syndrome,and Ig M levels are lower in patients with hyperthermia syndrome.The level may have certain guiding significance for the differentiation and prognosis of ITP.Traditional Chinese medicine treatment of ITP has a slow onset of effect,and combined Chinese and Western medicine treatment can increase the long-term response rate of treatment and reduce recurrence.The prescriptions for clearing heat and cooling blood,nourishing qi and nourishing yin have a certain effect on ITP,which deserves further study. |
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