【作者】 陈瑶；

【导师】 李达；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2011， 硕士

【摘要】 背景特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura, ITP)是种免疫介导的以外周血小板破坏增多引发的常见出血性疾病。糖皮质激素(Glucocorticoid, GC)是治疗的首选药物,但随着剂量减撤,部分对激素有效患者血小板下降而疾病反复,逐渐呈现激素依赖,从而明显影响患者生活质量。由于患者对目前常规的克服依赖手段,如有创的脾切除,毒副作用明显的细胞毒性药物,价格昂贵的促血小板生长因子及靶向疗法等不易接受,目前尚未很好解决激素依赖问题。中医院血液专科接诊的患者多数来自西医院服用激素而依赖,均系难以接受上述疗法,特此寻求中医药介入予以克服。对于激素依赖的认识与干预,现代中医也多从肾虚立论,主要在于消减由于依赖所带来的不良反应,且均出自激素依赖性哮喘、肾病综合征等疾病,对于本病的激素减撤、稳定血小板计数等文献稀少,效果不肯定。因此,对中医演变规律和证候的分布情况有总体的把握,然后在辨病与辨证论治的思想指导下进行遣方用药是中医药介入激素依赖性ITP治疗的必经之路。但是目前,国内的相关研究数据是缺如的。而本课题对于填补目前国内的研究空白,指导临床治疗至关重要。目的通过对广东省中医院血液科门诊及住院部诊断为激素依赖性特发性血小板减少性紫癜的病例进行分析,探讨激素依赖性ITP中医证候规律及激素依赖与中医证候变化之间关系。方法对广东省中医院血液科门诊或住院部诊断为激素依赖性特发性血小板减少性紫癜的病例进行分析,填写证候信息采集表,建立数据库进行统计分析。探讨激素依赖性ITP中医证型分布规律,分析激素依赖与中医证型之间关系。结果共收集病例100例；其中男性26例,女性74例,男女比例为：1：2.85；年龄最大80岁,最小4岁,平均年龄37.41岁,中位年龄为32岁。中医证候方面,共聚类出肝阴虚证、肝阴虚化火证、肝郁气滞证、脾气虚证、脾阳不足证、肾阴虚证、血瘀证、风湿袭表证等证候群。其中85%的病例聚类出脾气虚证候,70%为肝阴虚证,66%为血瘀证,15%为肾阴虚,11%为肝郁气滞证、风湿袭表证,8%为肝阴虚化火证。结论虚证类证候包括肝阴虚、脾气虚、肾阴虚。其的演变规律和激素应用和减撤相关。激素乃助样之品,长期应用易导致阴虚、气阴两虚。随着激素的减撤,逐渐演变成脾阳不足证。提示激素依赖性ITP患者在激素减撤过程中,应预见性地关注可能出现肾阳不足的证候而提前干预。实证类证候主要包括瘀、湿、气滞、血热,其中聚类出的血瘀证结果比例高,符合文献研究中ITP治疗经验对血瘀证贯穿始终的陈述;湿邪的致病特点与激素依赖性ITP病程特点一致,且岭南地区气候多湿,应重视治湿之法的应用。血热证是在阴虚证基础上发展而来的,提示治疗上不能一味地追求凉血药物的应用,需兼顾治疗后所带来虚证的存在。四大类别的聚类结果中,都出现情绪低沉、善太息、乳房、两胁胀闷不适等症状。提示本病好发于育龄期女性,容易产生情绪波动过激,导致肝郁气滞的证候。更多还原

【Abstract】 ObjectivesThe onset of Guangdong Hospital Of Traditional Chinese medicine outpatient department and network consulting hormone-dependent diagnosed cases of idiopathic thrombocytopenic purpura is analyzed. To explore syndromes glucocorticoid-dependent ITP regularity and hormone dependence and syndromes changes between relations.MethodsAnalyze the cases follow-up glucocorticoid-dependent ITP diagnosed from guangdong hospital of traditional Chinese medicine outpatient or network. then fill in the syndromes information collection table, create database to Statistical analysis. Discuss TCM syndrome hormone-dependent ITP type distribution rule. Analysis hormone dependence relationship between with TCM syndrome type. ResultAltogether collected cases 100 patients,26 cases of men and women 74 cases. The male to female ratio is:2～1.85. The oldest is 80 years, and the minimum age is 4 years old.The average age 37.41 years old and the median age is 32 years old. In the aspects of syndromes, copolymerize eight classes. They are Liver Yin deficiency syndrome, Liver Yin deficiency syndrome of fire, depressed liver and Qi obstruction syndrome, Spleen-deficiency syndrome, Spleen Yang deficiency syndrome, Kidney Yin deficiency syndrome, blood stasis syndrome, wind-damp incoming surface syndrome.85% of the cases is Spleen-deficiency syndrome,70% is Liver Yin deficiency syndrome,66% is blood stasis syndrome,15% is Kidney Yin deficiency syndrome,11% is depressed liver and qi obstruction syndrome and wind-damp incoming surface syndrome,8% is Liver Yin deficiency syndrome of fire. ConclusionDeficiency class syndrome include Liver Yin deficiency syndrome, Spleen-deficiency syndrome, Kidney Yin deficiency syndrome. The evolution is related to glucocorticoid applications and minus withdraw. Glucocorticoid is onyang, after prolonged application will appear Yin deficiency and Two empty qi and Yin. Along with the glucocorticoid withdrawal stop, gradually evolved into spleen Yang deficiency syndrome. It prompt that glucocorticoid withdrawal process reduced, should concern may appear kidney Yang deficiency syndromes and early intervention.Empirical class syndrome include Stasis, wet,qi stagnancy and blood heat. The proportion of blood stasis syndrome is the highest.It comply with the literature research on the treatment experience of ITP blood stasis throughout’s statement. The pathogenic characteristics of damp evil is consistent with the course features of glucocorticoid-dependent ITP. How wet climate lingnan area, Should attach importance to the healing method of damp evil. Blood heat syndromes is the basis of the development in Yin deficiency syndrome. The treatment can not blindly pursuing on the application of medicines cool blood. We need to juggle the therapy to brought by the existence of deficiency syndrome. In four categories of clustering results, all appear gloomy mood, have a deep sign, breast, two stalking, bilge stuffy discomfort and other symptoms. The disease occurs in women of reproductive age, easy to produce the mood swings ultra. Then cause stomach qi stagnancy and syndromes.更多还原