【作者】 俞亚琴；

【导师】 孙伟正；

【作者基本信息】 黑龙江中医药大学 ， 中医内科学， 2004， 博士

【摘要】 为了探讨补髓生血颗粒对慢性再障患者(CAA)的作用机制。本研究采用单盲法将60例慢性再障患者随机分为补髓生血颗粒组和再障生血片对照组，对其临床疗效、骨髓活检组织和骨髓基质细胞细胞粘附分子和粘附能力进行了观察分析和实验研究。 采用免疫荧光法检测慢性再障患者治疗前后骨髓基质细胞(BMSC)血小板内皮细胞粘附分子(PECAM／CD31)、淋巴细胞归巢受体(HCAM／CD44)、细胞间粘附分子(ICAM／CD54)、血管细胞粘附分子(VCAM／CD106)抗原水平表达。采用MTT方法检测其骨髓基质细胞对正常骨髓造血细胞和再障患者细胞的粘附能力。 结果显示：1、补髓生血颗粒治疗CAA疗效优于再障生血片，阳虚型疗效优于阴虚型，且阳虚型患者骨髓基质细胞粘附分子水平较阴虚型患者更易恢复。2、补髓生血颗粒可改善骨髓诸类组织含量异常病理状态，使造血组织面积明显增加，脂肪组织明显减少，小血管数量增加，恢复骨髓的造血功能。3、两组患者治疗前PECAM／CD31、HCAM／CD44、ICAM／CD54、VCAM／CD106粘附分子水平明显低于正常对照组，治疗后两组患者PECAM／CD31、HCAM／CD44、ICAM／CD54、VCAM／D106抗原水平都有不同程度的升高，并且补髓生血颗粒对PECAM／CD31、VCAM／CD106抗原水平的提高方面优于再障生血片对照组。4、CAA BMSC对骨髓造血细胞粘附能力明显下降，治疗后两组患者其粘附能力提高，且补髓生血颗粒组优于再障生血片对照组。 结论：补髓生血颗粒治疗CAA，疗效优于再障生血片，进一步证实了“阳虚易治，阴虚难调”的理论。补髓生血颗粒可改善骨髓诸类组织含量异常病理状态，恢复骨髓的造血功能。慢性再障患者BMSC的粘附分子PECAM／CD31、HCAM／CD44、ICAM／CD54、VCAM／CD106的表达水平下降，且对骨髓造血细胞粘附能力下降，补髓生血颗粒可提高PECAM／CD31、HCAM／CD44、ICAM／CD54、VCAM／CD106粘附分子的表达和提高CAA BMSC对骨髓造血细胞粘附能力，从而促进慢性再障患者的骨髓造血。更多还原

【Abstract】 For discussing the mechanism of marrow-supplementing and blood-engendering granule to chronic aplastic anemia (CAA) patients, this study employed single blind procedure to divide sixty CAA patients into marrow- supplementing and blood-engendering granule group and ZaiZhang ShengXue tablet group randomly and made observation and experiment on its clinical curative effect, live bone marrow examination constitution, bone marrow stromal cell (BMSC) adhesion molecule and adhesion function.This experiment employed iminumofluorescence method to examine the expression level of plalete endothelial cell adhesion molecule (PECAM/CD31), lymphocyte homing receptor(HCAM/CD44), intercellular adhesion molecule ( ICAM/CD54 ) , vascular cell adhesion molecule ( VCAM/ CD106) antigen in BMSC of CAA patients before and after treatment. This experiment used MMT method to test the adhesion function of BMSC in CAA patients to the normal and CAA patients bone hemopoietic cells.Result: 1. The effect of marrow-supplementing and blood-engendering granule to CAA was superior to that of ZaiZhang ShengXue tablet. In the marrow-supplementing -and blood-engendering granule group, its curative effect was superior in Yang deficiency type to that in Yin deficiency type, and the recovery of adhesion function of BMSC in Yang deficiency type was easier than that in Yin deficiency type. 2. Marrow-supplementing and blood-engendering granule can ameliorate pathologic status in many tissues in bone marrow, increase the area of hematopoietic tissue, redcuce adipose tissue, raise the amount of small vessels, and recover hematopoietic function in bone marrow. 3. The content of PECAM/CD31, HCAM/CD44,ICAM/CD54, VCAM/CD106 adhesion molecule in patients of the two groups were lower than that in the normal controlled group markedly before treatment. After treatment, the content of PECAM/CD31 , HCAM/CD44 , ICAM/CD54 , VCAM/CD106 antigen in two groups had all been advanced in different digree, and the advancement of PECAM/CD31, VCAM/CD106 antigen in group group. 4.The adhesion function of BMSC in CAA patients to bone hemopoietic cells descended markedly, after treatment the adhesion function in two groups was enhanced, and the enhancement in marrow-supplementing and blood-engendering granule group was superior to that in ZaiZhang ShengXue tablet group.Conclusion: The effect of marrow-supplementing and blood-engendering granule to CAA is superior to that of ZaiZhang ShengXue tablet. Our experiments further testified the theory ’Yin deficiency is easy to treat, but Yang deficiency is difficult to treat.’ Marrow-supplementing and blood-engendering granule can ameliorate pathologic status in many tissues in bone marrow, and recover hematopoietic function in bone marrow.The expression level of adhesion molecule PECAM/CD31 , HCAM/CD44, ICAM/CD54 , VCAM/CD106 in CAA patients declined, and its adhesion function to bone hemopoietic cells also descended. Marrow-supplementing and blood-engendering granule can enhance expression level of adhesion molecule PECAM/CD31, HCAM /CD44, ICAM/CD54, VCAM/CD106 and the adhesion function of CAA BMSC to bone hemopoietic cells, therefore enhance the hemopoietic function of bone marrow.更多还原