枸杞二黄汤加味联合小剂量美罗华对利奈唑胺药物性血小板减少症相关指标的影响
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摘要
目的探讨枸杞二黄汤加味联合小剂量美罗华治疗利奈唑胺药物性血小板减少症的相关指标的影响。方法选取104例因利奈唑胺导致血小板减少症的患者,采用随机数字表法分为对照组及研究组,每组52例。对照组在常规治疗的基础上给予小剂量美罗华治疗,研究组在对照组的基础上给予枸杞二黄汤加味联合小剂量美罗华治疗,同时选择健康者52例作为健康组,分别对研究组、对照组及健康组患者进行治疗前后血清白介素-33(IL-33)、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)和血小板、白细胞、血红蛋白水平、肝功能及肾功能检测,观察其变化情况。结果治疗前研究组及对照组患者血清IL-33、TNF-α和IFN-γ水平明显高于健康组,血小板、血红蛋白和白细胞水平明显低于健康组,差异有统计学意义(P <0. 05),且对照组和治疗组患者上述指标相比较差异无统计学意义(P>0. 05);治疗后对照组和治疗组患者血清IL-33、TNF-α和IFN-γ水平均明显下降,血小板计数明显上升,且研究组上述指标水平明显低于对照组(P <0. 05);治疗后对照组和治疗组患者的白细胞、血红蛋白以及肝、肾功能水平同治疗前比较,差异无统计学意义(P> 0. 05)。结论枸杞二黄汤加味联合小剂量美华罗治疗利奈唑胺药物性血小板减少症可有效降低患者的血清IL-33、TNF-α及IFN-γ水平,提高患者的血小板计数,但对于白细胞及血红蛋白指数的改善情况不明显,值得临床进一步推广探究。
Objective To investigate the effects of Gouqierhuang decoction combined with small dose of rituximab on the related indexes in the patients with drug-induced thrombocytopenia. Methods A total of 104 patients with drug-induced thrombocytopenia. Who were treated in our hospital were enrolled in the study. According to random digital table method,these patients were divided into control group( n = 52) and research group( n = 52). The patients in contrl group,on the basis of routine therapy,were treated by small dose of mabthera,however,the patients in research group,on the basis of control group,were treated by Gouqierhuang decoction,at the same time,the other 52 healthy subjects were enrolled as health control group.The serum levels of IL-33 TNF-alpha( TNF-α) and IFN-gamma( IFN-γ),platelet,WBC,hemoglobin,liver function before and after treatment were observed and compared among the three groups. Results Before treatment the serum levels of IL-33,TNF-α and IFN-γ in research group and control group were significantly higher than those in healthy control group,however,the levels of platelet,WBC,hemoglobin were significantly lower than those in healthy control group( P < 0. 05),moreover,there were no significant differences in above indexes between research group and control group( P > 0. 05). After treatment the serum levels of IL-33,TNF-α and IFN-γ in research group and control group were significantly decreased,and platelet count was significantly increased,moreover,the levels of these indexes in research group were significantly lower than those in control group( P < 0. 05). In addition after treatment there were no snificant differences in thelevelsof WBC,hemoglobin,liver function,kidney function between control group and research group( P > 0. 05). Conclusion Gouqierhuang decoction combined with small dose of rituximab in treatment of drug-induced thrombocytopenia can effectively decrease the serum levels of IL-33,TNF-α and IFN-γ,and increase blood platelet count,nut,which can not improve WBC and hemoglobin obviously,which needs to be reearched further.
Objective To investigate the effects of Gouqierhuang decoction combined with small dose of rituximab on the related indexes in the patients with drug-induced thrombocytopenia. Methods A total of 104 patients with drug-induced thrombocytopenia. Who were treated in our hospital were enrolled in the study. According to random digital table method,these patients were divided into control group( n = 52) and research group( n = 52). The patients in contrl group,on the basis of routine therapy,were treated by small dose of mabthera,however,the patients in research group,on the basis of control group,were treated by Gouqierhuang decoction,at the same time,the other 52 healthy subjects were enrolled as health control group.The serum levels of IL-33 TNF-alpha( TNF-α) and IFN-gamma( IFN-γ),platelet,WBC,hemoglobin,liver function before and after treatment were observed and compared among the three groups. Results Before treatment the serum levels of IL-33,TNF-α and IFN-γ in research group and control group were significantly higher than those in healthy control group,however,the levels of platelet,WBC,hemoglobin were significantly lower than those in healthy control group( P < 0. 05),moreover,there were no significant differences in above indexes between research group and control group( P > 0. 05). After treatment the serum levels of IL-33,TNF-α and IFN-γ in research group and control group were significantly decreased,and platelet count was significantly increased,moreover,the levels of these indexes in research group were significantly lower than those in control group( P < 0. 05). In addition after treatment there were no snificant differences in thelevelsof WBC,hemoglobin,liver function,kidney function between control group and research group( P > 0. 05). Conclusion Gouqierhuang decoction combined with small dose of rituximab in treatment of drug-induced thrombocytopenia can effectively decrease the serum levels of IL-33,TNF-α and IFN-γ,and increase blood platelet count,nut,which can not improve WBC and hemoglobin obviously,which needs to be reearched further.
引文
1 Natsumoto B,Yokota K,Omata F,et al.Risk factors for linezolidassociated thrombocytopenia in adult patient.Infection,2014,42:1007-1012.
2包旻,姜玲,孙言才,等.某“三甲”医院利奈唑胺注射剂临床应用合理性评价.中国药房,2012,13:881-883.
3 Niwa T,Suzuki A,Sakakibara S,et al.Retrospective cohortchart review study of factors associated with the development of thrombocytopenia in adult Japanese patients who receivedintravenous linezolid therapy.Clin Ther,2009,31:2126-2133.
4 Emma B,Sharmila M,Benjamin P,et al.Good clinical outcomes but high rates of adverse reaction during linezolid therapy for serious infections:aproposed protocol for monitoring therapy in complex patients.Antimicrob Agents Ch,2006,50:1599-1602.
5叶燕文,刘贵章,赖应昌,等.小剂量美罗华治疗原发免疫性血小板减少症的临床疗效观察.海峡药学,2015,27:207-208.
6张之南,沈悌主编.血液病诊断及疗效标准.第3版.北京:科学出版社,2007.172-175.
7郑筱萸主编.中药新药临床指导原则(试行).第1版.北京:中国医药科技出版社,2002.177.
8张玉珍主编.中医妇科学.第1版.北京:中国中医药出版社,2004.121-124.
9邓冬祥.血管紧张素Ⅱ受体阻断剂诱发免疫性血小板减少症一例.海南医学,2015,26:3581-3582.
10郝丽杰,杨伟,马丽娜,等.利奈唑胺治疗高龄重症肺炎致血小板减少16例临床分析.现代生物医学进展,2012,12:6487-6488,6495.
11古丽拜尔·卡哈尔,侍效春,刘晓清,等.利奈唑胺临床治疗安全性分析.中国全科医学,2013,16:2296-2298.
12 Green SL,Maddox JC,Huttenbach ED.Linezolid and reversible myelosuppression.JAMA,2001,285:1291.
13 Gorchynski J,Rose JK.Complications of MRSA treatment:lin-ezolidinduced myelosuppression presenting with pancytopenia.West J Emerg Med,2008,9:177-178.
14高举,罗春华.自身免疫性血小板减少性紫癜的发病机制及诊治进展.中国实用儿科杂志,2003,18:77-79.
15丁艳,张晓玲,徐浩,等.小剂量美罗华联合新鲜冰冻血浆治疗难治性免疫性血小板减少症疗效观察.中外医学研究,2013,11:12-13.
16刘月波,周泽平,杨红,等.小剂量美罗华治疗原发免疫性血小板减少症的临床疗效观察.昆明医科大学学报,2012,33:99-101.
17孙梅,顾健,何斌,等.小剂量美罗华联合冰冻血浆治疗免疫性血小板减少症.血栓与止血学,2010,16:18-20.
18余上才.构杞子和白术免疫调节作用的实验研究.上海免疫学杂志,1994,14,12.
19耽映君,孙建宁,邓文龙主编.掌中药药理学.第2版.北京:人民卫生出版社.2011.812.
20 Sims JE,Smith DE.The IL-1 family:regulators of immunity.Nat Rev Immunol,2010,10:89-102.
21孙海斌,王晓蕾,郁敏,等.急性免疫性血小板减少症患儿血清IL-33检测及其意义.现代免疫学,2012,32:506-508.
22张国利,张剑白,蒋丽鑫.特发性血小板减少性紫癜患儿血清IL-6,s IL-2R的变化及意义.哈尔滨医科大学学报,2009,43:486-487.
23刘现辉,郭晓娜.补气消癜汤对免疫性血小板减少症模型小鼠的白细胞介素系列因子及TNF-α的影响.中华中医药学报,2017,3:196-199.
24李文静,王志伟,孙永利,等.小剂量美罗华联合冰冻血浆对利奈唑胺所致血小板减少症患者血清细胞因子水平的影响.海军医学杂志,2017,38:442-444.
2包旻,姜玲,孙言才,等.某“三甲”医院利奈唑胺注射剂临床应用合理性评价.中国药房,2012,13:881-883.
3 Niwa T,Suzuki A,Sakakibara S,et al.Retrospective cohortchart review study of factors associated with the development of thrombocytopenia in adult Japanese patients who receivedintravenous linezolid therapy.Clin Ther,2009,31:2126-2133.
4 Emma B,Sharmila M,Benjamin P,et al.Good clinical outcomes but high rates of adverse reaction during linezolid therapy for serious infections:aproposed protocol for monitoring therapy in complex patients.Antimicrob Agents Ch,2006,50:1599-1602.
5叶燕文,刘贵章,赖应昌,等.小剂量美罗华治疗原发免疫性血小板减少症的临床疗效观察.海峡药学,2015,27:207-208.
6张之南,沈悌主编.血液病诊断及疗效标准.第3版.北京:科学出版社,2007.172-175.
7郑筱萸主编.中药新药临床指导原则(试行).第1版.北京:中国医药科技出版社,2002.177.
8张玉珍主编.中医妇科学.第1版.北京:中国中医药出版社,2004.121-124.
9邓冬祥.血管紧张素Ⅱ受体阻断剂诱发免疫性血小板减少症一例.海南医学,2015,26:3581-3582.
10郝丽杰,杨伟,马丽娜,等.利奈唑胺治疗高龄重症肺炎致血小板减少16例临床分析.现代生物医学进展,2012,12:6487-6488,6495.
11古丽拜尔·卡哈尔,侍效春,刘晓清,等.利奈唑胺临床治疗安全性分析.中国全科医学,2013,16:2296-2298.
12 Green SL,Maddox JC,Huttenbach ED.Linezolid and reversible myelosuppression.JAMA,2001,285:1291.
13 Gorchynski J,Rose JK.Complications of MRSA treatment:lin-ezolidinduced myelosuppression presenting with pancytopenia.West J Emerg Med,2008,9:177-178.
14高举,罗春华.自身免疫性血小板减少性紫癜的发病机制及诊治进展.中国实用儿科杂志,2003,18:77-79.
15丁艳,张晓玲,徐浩,等.小剂量美罗华联合新鲜冰冻血浆治疗难治性免疫性血小板减少症疗效观察.中外医学研究,2013,11:12-13.
16刘月波,周泽平,杨红,等.小剂量美罗华治疗原发免疫性血小板减少症的临床疗效观察.昆明医科大学学报,2012,33:99-101.
17孙梅,顾健,何斌,等.小剂量美罗华联合冰冻血浆治疗免疫性血小板减少症.血栓与止血学,2010,16:18-20.
18余上才.构杞子和白术免疫调节作用的实验研究.上海免疫学杂志,1994,14,12.
19耽映君,孙建宁,邓文龙主编.掌中药药理学.第2版.北京:人民卫生出版社.2011.812.
20 Sims JE,Smith DE.The IL-1 family:regulators of immunity.Nat Rev Immunol,2010,10:89-102.
21孙海斌,王晓蕾,郁敏,等.急性免疫性血小板减少症患儿血清IL-33检测及其意义.现代免疫学,2012,32:506-508.
22张国利,张剑白,蒋丽鑫.特发性血小板减少性紫癜患儿血清IL-6,s IL-2R的变化及意义.哈尔滨医科大学学报,2009,43:486-487.
23刘现辉,郭晓娜.补气消癜汤对免疫性血小板减少症模型小鼠的白细胞介素系列因子及TNF-α的影响.中华中医药学报,2017,3:196-199.
24李文静,王志伟,孙永利,等.小剂量美罗华联合冰冻血浆对利奈唑胺所致血小板减少症患者血清细胞因子水平的影响.海军医学杂志,2017,38:442-444.