中西药结合辩证治疗老年再生障碍性贫血的效果分析及对血清肿瘤坏死因子α的影响

摘要

目的 探讨中西药结合辩证治疗老年再生障碍性贫血的效果及对血清肿瘤坏死因子α(TNF-α)水平的影响.方法 选择2011年9月至2013年4月于湖北医药学院附属东风医院进行治疗的老年再生障碍性贫血患者72例,根据中医辨证分型分为肾阳虚型组(40例)和肾阴虚型组(32例).2组均采用中西药结合辨证治疗:康力龙6 ～ 12 mg/d+左旋咪唑150 mg/d口服,3次/周;大剂量甲基泼尼松龙0.5 ～1.0 g/(kg·d)静脉滴注,连用3～5d;抗淋巴细胞球蛋白/抗胸腺细胞球蛋白10～20 mg/(kg·d)静脉滴注,连用4～7d;自拟中药方口服,3次/d.所有患者均治疗3个月.治疗前检测血清铁、TNF-α、红细胞沉降率(ESR)、血红蛋白水平,治疗后检测TNF-α水平.采用Pearson相关检验分析贫血症状评分与实验室检测指标的相关性,比较2组治疗前后TNF-α水平、贫血症状评分和临床疗效.结果 血红蛋白、TNF-α、ESR、血清铁含量与贫血症状评分有明显相关性(r=0.625、0.357、0.421、0.388,均P＜0.05).治疗后,肾阳虚型组和肾阴虚型组TNF-α水平和贫血症状评分均低于治疗前[(13±8) ng/L比(29±5)ng/L,(14 ±8) ng/L比(29±5) ng/L;(4.3±1.2)分比(13.9±2.2)分,(4.8±1.9)分比(13.8±2.5)分],差异均有统计学意义(均P ＜0.05).但2组治疗前后比较,差异均无统计学意义(均P＞0.05).治疗后,肾阳虚型组与肾阴虚型组的总有效率分别为97.5％ (39/40)和90.6％(29/32),2组比较差异无统计学意义(P＞0.05).结论 中西药结合辨证治疗老年再生障碍性贫血能取得较好的临床效果,且可降低血清TNF-α水平.%Objective To investigate the effect of Chinese combined with western medicine in treating aplastic anemia and influence on tumor necrosis factor α (TNF-α) in elderly patients.Methods Totally 72 elderly patients with aplastic anemia from September 2011 to April 2013 were enrolled and divided into kidney Yang deficiency group (40 cases) and kidney Yin deficiency group (32 cases).Oral administration of stanozolol (6-12 mg/d, 3 times per week) + levamisole (150 mg/d, 3 times per week) was given as basic treatment;intravenous drip of methylprednisolone [0.5-1.0 g/(kg · d) for 3-5 d] and antilymphocyte globulin/antithymocyte globulin [10-20 mg/(kg · d) for 4-7 d] were administrated followed by oral traditional medicine according to the prescriptions (3 times/d).The treatment was lasted for 3 months.The levels of iron and TNF-α in serum, erythrocyte sedimentation rate (ESR), hemoglobin were tested before treatment.Pearson correlation test was used to determine the correlations between anaemic symtom scores and laboratory test indices.The TNF-α level, anaemic symptom scores and clinical curative effect were compared between groups.Results The hemoglobin, TNF-α, ESR and serum iron were significantly correlated to anaemic symtom scores (r =0.625, 0.357, 0.421, 0.388 ,P ＜ 0.05).After treatment, the serum TNF-α level and anemia symptom score were significantly lower than those before treatment in both kidney Yang deficiency group[(13 ±8) ng/L vs (29 ±5) ng/L, (4.3 ± 1.2) scores vs(13.9 ± 2.2) scores] and kidney Yin deficiency group [(14 ±8) ng/L vs (29 ±5) ng/L, (4.8 ± 1.9) scores vs (13.8 ± 2.5) scores] (P ＜ 0.05), while no statistical differences were found between the two groups (P ＞ 0.05).The effective rate was not significantly different between Yang deficiency group and kidney Yin deficiency group [97.5％ (39/40) vs 90.6％ (29/32)] (P ＞0.05).Conclusion Western medicine combined with traditional Chinese medicine can achieve better prognosis in treating aplastic anemia and reduce the level of TNF-α in serum in elderly patients.