BACKGROUND:Therapeutic strategies for myelodysplastic syndrome/myeloproliferative neoplasms (MDS/MPNs) remain suboptimal. Selinexor, an oral selective inhibitor of exportin 1, represents a mechanism-based therapeutic approach. Preclinical and clinical evidence indicated synergistic antileukemic effects when selinexor was combined with hypomethylating agents or janus kinase inhibitors. METHODS:A prospective, single-arm trial was conducted to evaluate selinexor plus either azacitidine (for MDS-dominant features) or ruxolitinib (for MPN-dominant features) in patients with MDS/MPN. The primary end point was the overall response rate at 6 months, which was assessed according to 2015 International Working Group criteria. Secondary end points included safety, progression, and survival. RESULTS:Twenty patients were enrolled (four with MDS-dominant features, 16 with MPN-dominant features). The median age was 66 years in the MDS group and 62.5 years in the MPN group. The overall response rate was 60% (12 of 20 patients; 95% confidence interval [CI], 36.1%-80.5%) overall, 75% (three of four patients; 95% CI, 31.1%-95.4%) in the MDS group, and 56.3% (nine of 16 patients; 95% CI, 33.2%-76.9%) in the MPN group. In the MDS group, clinical benefits included improvements in the total symptom score, erythroid response, platelet response, and spleen response (one in each of four patients; 25% for each response). In the MPN group, partial responses occurred in two of 16 patients (12.5%), and partial bone marrow responses occurred in three of 16 (18.8%), with additional benefits including spleen response (five of 16; 31.3%), total symptom score improvement (two of 16; 12.5%), erythroid response (two of 16; 12.5%), and platelet response (one of 16; 6.3%). Adverse events occurred in 14 patients (70%). Three patients experienced grade 3 or greater events, including two disease-related fatalities. After a median follow-up of 6 months (range, 2-15 months), one patient's disease transformed to acute myeloid leukemia. CONCLUSIONS:Selinexor combined with azacitidine or ruxolitinib showed encouraging efficacy with a manageable safety profile in patients with MDS/MPN.

Background and aimsAnemia is a widespread global health concern, and recent research has unveiled a link between anemia and inflammation. The Dietary Inflammation Index (DII) is a novel tool used to assess the overall inflammatory potential of an individual’s diet. However, until now, there have been no studies demonstrating a connection between DII and anemia. This study aimed to explore the relationship between DII and the risk of anemia among Americans, as well as to examine the influence of other risk factors on this association.MethodsData from 32,244 patients were collected from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018. Using multivariable logistic regression, we examined the correlation between DII and anemia. Subgroup analyses and smoothed curve analyses were conducted to further investigate the association between DII and anemia.ResultsThe analysis revealed a significant positive association between higher DII scores and increased anemia risk in the American population (Odds Ratio [OR] = 1.06, 95% Confidence Interval [CI] = 1.03 to 1.09, p < 0.0001). This association remained consistent in subgroup analyses, encompassing various age groups, distinct Body Mass Index (BMI) categories, varying diabetes mellitus statuses, histories of hypertension, females, individuals with a RIP <3.5, and Non-Hispanic Black individuals. Notably, the association was particularly significant among non-smokers. Smoothed curve fitting analysis demonstrated a linear relationship between DII and the prevalence of anemia.ConclusionOur findings underscore a positive correlation between the inflammatory potential of one’s diet and the risk of anemia, especially when coupled with other risk factors. Consequently, reducing the consumption of pro-inflammatory foods may serve as one of the effective measures against the development of anemia. Given the variations in gender, age, BMI, and chronic diseases observed in our study, tailored policies could better cater to the specific needs of diverse populations.

Initial research indicates a possible connection between exposure to phthalates and the development of anemia. To fill the gap in epidemiological data, our study utilized data from across the United States, representative on a national scale, to evaluate the association between the concentration of phthalate metabolites in urine and both anemia and iron levels. We gathered data on 11,406 individuals from the National Health and Nutrition Examination Survey (NHANES) database, spanning 2003-2018. We conducted logistic and linear regression analyses, adjusted for potential confounding factors, to evaluate the correlations between different phthalate metabolites and anemia, as well as serum iron levels, including gender-stratified analysis. Most urinary phthalate metabolites were positively correlated with an increased risk of anemia, and the majority were negatively correlated with serum iron levels. The study revealed that for every unit increase in ln-transformed metabolite concentrations, the odds ratios (ORs) for anemia increased to varying degrees, depending on the phthalate: Monobutyl phthalate (MBP) at 1.08 (95% CI 1.01-1.17, P = 0.0314), mono(3-carboxypropyl) phthalate (MCPP) at 1.17 (95% CI 1.10-1.24, P < 0.0001), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) at 1.08 (95% CI 1.02-1.15, P = 0.0153), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP) at 1.14 (95% CI 1.07-1.21, P < 0.0001), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) at 1.11 (95% CI 1.03-1.18, P = 0.0030), monocarboxynonyl phthalate (MCNP) at 1.11 (95% CI 1.03-1.19, p = 0.0050), and monocarboxyoctyl phthalate (MCOP) at 1.13 (95% CI 1.07-1.19, P < 0.0001). Increased levels of MBP, MEHP, MBzP, MCPP, MEHHP, MEOHP, MIBP, MECPP, MCNP, and MCOP were linked with changes in serum iron levels, ranging from - 0.99 g/dL (95% CI - 1.69 to - 0.29) to - 3.72 mu g/dL (95% CI - 4.32 to - 3.11). Mixed-exposure analysis shows consistency with single-exposure model. Further mediation analysis showed that the association between single urinary phthalates and the risk of anemia was mediated by serum iron with a mediation ratio of 24.34-95.48% (P < 0.05). The presence of phthalate metabolites in urine shows a positive correlation with the prevalence of anemia, which was possibly and partly mediated by iron metabolism. Nonetheless, to confirm a definitive causal link and comprehend the underlying mechanisms of how phthalate exposure influences anemia, additional longitudinal and experimental research is required.

融合基于案例教学法与二维四阶教学法的精髓,将基于案例教学法的二维四阶教学法引入到中医血液学的教学中,使学生更好地理解和掌握中医血液学的基础理论知识,提高学生的临床技能和临床诊疗思维,探索一种有效的临床教学模式.

Few effective therapies are available to treat patients with relapsed/refractory myelodysplastic neoplasms (MDS). Luspatercept was shown to display good efficacy in a phase 3 clinical trial for lower-risk MDS (LR-MDS) patients, yet real-world data are limited, especially in China. Therefore, data from patients diagnosed as having MDS with low blasts and SF3B1 mutation (MDS-SF3B1) and MDS with SF3B1 mutation and thrombocytosis were retrospectively analyzed. Of the 23 enrolled patients, 17 (73.9

Aims: To compare cyclosporine (CSA) combining eltrombopag (EPAG) with or without antithymocyte globulin (ATG) in aplastic anemia (AA) patients in the real world.Methods: AA patients who received ATG combining CSA and EPAG (Group A) and CSA + EPAG (Group B) as front-line treatment in 13 medical centers in China were enrolled. The efficacy and safety were compared.Results: A total of 89 patients were enrolled with 51 patients in Group A and 38 patients in Group B. The 6-month overall response (OR)/complete response (CR) was 73.3%/24.4% and 60.6%/27.3% in Groups A and B (p > .1). For severe AA patients, the 6-month OR was 74.1% versus 50% and 6-month CR was 25.9% versus 20% in Groups A and B (p > 0.1). Multivariate analysis showed gender affects the 6-month OR with females better OR (p = .017, OR 6.045, 95% CI: 1.377-26.546) and time from disease onset to treatment affected the 12-month CR (p = .026, OR 0.263, 95% CI: 0.081-0.852). No difference was found in side effects except ATG infusion reaction and serum sickness. Mortality was 7.8% in Group A and no patient died in Group B.Conclusions: CSA + EPAG had a similar response and less side effects compared with standard immunosuppressive therapy + EPAG in newly diagnosed AA.

Context Myelodysplastic syndrome (MDS) is a group of highly heterogeneous, malignant clonal diseases derived from hematopoietic stem cells. PD-1 monoclonal antibodies can have a synergistic effect with hypomethylating agents (HMAs), especially for patients with drug resistance to demethylation drugs. TCM in the treatment of MDS can improve hematological indexes, and for some patients, control the proliferation of primitive cells and delay or even block the transformation to leukemia. Objective The study intended to examine the therapeutic effects of programmed cell death-1 (PD-1) inhibitors and azacitidine combined with the Yisuifang Thick Decoction in the treatment of MDS with older, high-risk patients. Design The research team performed five prospective case studies. Setting The study took place at the East Hospital affiliated with Beijing University of Chinese Medicine in Beijing, China. Participants Participants were five older, high-risk MDS patients at the hospital who received PD-1 and azacitidine combined with Yisuifang Thick Decoction between April 2020 and June 2021. Outcome Measures The research team measured: (1) treatment duration, (2) curative effects, (3) myelosuppression, (4) immune-related adverse reactions, (5) ending outcomes, and (6) progression-free survival (PFS). Results The male to female ratio for the five participants was 3:2, and the median age was 69 years, with a range from 62 to 79 years. Four participants had refractory HR-MDS and one had primary MDS. The median treatment duration was 3 months, with a range from 2 to 4 months, and the median progression-free survival (PFS) was 5 months, with a range from 3 to 14 months. All participants achieved a partial response (PR) or a complete remission with incomplete count recovery (CRi) and showed improvement in serological indexes. Conclusions Older, high-risk MDS patients generally have poor physical conditions, often accompanied by a poor karyotype prognosis and a poor prognosis for survival. Therefore, the combination of PD-1, azacytidine, and Yisuifang Thick Decoction may be an effective way to treat HR-MDS.

1 病例资料 患者,女性,81岁,主诉因"吞咽困难反复发作2 月余"于2021年12月23日就诊于北京中医药大学东方医院消化科门诊,诊断"吞咽困难查因",服用促胃肠动力药效果不佳,12 月29日查13 C呼气试验阳性;胃镜示:胃体下部及体窦交界处可见环周病变,呈浸润性生长,边界不清,病变粗糙,伴多发浅溃疡形成,病变累及胃角,触碰易出血(图1),活检标本送病理,随后行四联根除幽门螺旋杆菌( campylobacter pylori, HP)治疗.2022年1月4日病理示:胃体下部大弯、胃体下部前臂、胃角中部、胃角后壁胃黏膜组织重度慢性炎,中度活动,固有层内可见多处、弥漫淋巴组织增生,部分细胞异型,建议专科会诊除外淋巴造血系统肿瘤.

目的:观察补肾填精方联合西药治疗再生障碍性贫血(AA)对血小板(PLT)的影响,分析影响PLT的临床因素特征.方法:选取2018 年9 月至2021 年3 月中国中医科学院西苑医院、广安门医院等 19 个分中心的AA患者 79 例作为研究对象,以补肾填精方联合西药基础治疗,连用3 个月为 1 个疗程,连续服用2 个疗程,观察患者PLT变化情况,分析PLT较基线值增长且恢复正常、较基线值增长未恢复正常的AA患者的临床因素特征.结果:AA患者接受补肾填精方联合西药治疗4 个月后,PLT较基线值增长且恢复正常的有 13 例,PLT较基线值增长未恢复正常的有66 例.对一般资料分析显示,中医证候积分越低,补肾填精方联合西药治疗,PLT越容易恢复正常(P＜0.05).对治疗前血常规分析结果显示,治疗前血红蛋白≥60 g/L时、中性粒细胞数值越高时、网织红细胞比率＜0.5%时,补肾填精方联合西药治疗,PLT越容易恢复正常(P＜0.05).对治疗前T淋巴细胞亚群结果分析显示,CD3+CD19-＜60%时,以补肾填精方联合西药治疗,PLT更容易恢复正常(P＜0.05).结论:当AA患者的中医证候积分越低、血红蛋白≥60 g/L、中性粒细胞数值越高、网织红细胞比率＜0.5%、CD3+CD19-＜60%且越低时,以补肾填精方联合西药治疗,AA患者的PLT更容易增加并恢复正常(P＜0.05).

目的:探讨补肾生血方与益气养血方治疗慢性再生障碍性贫血疗效及T细胞亚群与T-box家族的新型转录因子(T-bet)、Gata转录因子家族的转录因子3(GATA3)表达的影响.方法:收集2018年5月至2021年6月,在全国19家医院就诊的慢性再生障碍性贫血患者共585例,利用前瞻性、双盲、随机对照方法,采用分层区组随机法将患者分为3组,肾虚组、气血两虚组、对照组,中药治疗分别予补肾生血方颗粒、益气养血方颗粒、安慰剂(半量补肾生血方颗粒),均联合口服西药环孢素及雄激素.每组治疗以3个月为一疗程,连续观察2个疗程,分析治疗前后检测患者血常规,T细胞亚群及融合基因T-bet、GATA3,并监测安全性指标.结果:观察期间共脱落75例,剔除18例,最终肾虚组161例,气血两虚组164例,对照组167例,共492例完成治疗.治疗6个月后,肾虚组的总有效率98.8％(159/161)高于气血两虚组的79.9％(131/164)(x2=30.135,P＜0.01);肾虚组明显高于对照组的总有效率61.7％(103/167)(x2=70.126,P＜0.01);气血两虚组总有效率高于对照组(x2=13.232,P＜0.01).与本组治疗前比较,治疗后3组患者的血红蛋白(HGB)明显提升(P＜0.05,P＜0.01),且肾虚组HGB含量提高更为显著(P＜0.01);治疗后与气血两虚组比较,肾虚组与对照组的白细胞(WBC)及血小板(PLT)均显著升高(P＜0.01);3组患者治疗后的中性粒细胞(ANC)差异无统计学意义.3组患者在相同时间点进行比较,肾虚组T辅助细胞1(Th1)、Th1/Th2水平均明显降低(P＜0.05),且肾虚组CD4+水平明显下降,CD4+/CD8+明显降低(P＜0.05).肾虚组与其余两组CD 19-、HLA/DR+、CD25+比较差异无统计学意义,肾虚组与对照组T-bet均低于气血两虚组(P＜0.05).结论:补肾生血方治疗再生障碍性贫血可能通过改善免疫调节机制,抑制免疫系统活性,调节T细胞亚群,抑制Th1及CD4+水平,促进骨髓造血,且安全、不良反应小,方案值得进一步推广.

We explored the mechanisms and molecular targets of Ejiao Siwu Decoction (EJSW) for treating primary immune thrombocytopenia (ITP) using network pharmacology and molecular docking. Active compounds of EJSW were identified by high-performance liquid chromatography-diode array detector (HPLC-DAD) and high-performance liquid chromatography-mass spectrometry (HPLC-MS) and their targets were obtained from HERB and SwissTargetPrediction, and ITP targets were obtained from Comparative Toxicogenomics Database (CTD) and GeneCards. STRING and Cytoscape were used for protein-protein interaction (PPI) network analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses by WebGestalt yielded a gene-pathway network, Autodock molecular docking was applied to screen targets and active compounds, and cytokines were detected using a cytometric bead array (CBA) human inflammation kit. We identified 14 compounds and 129 targets, and 1,726 ITP targets. RAC-alpha serine/threonine-protein kinase (AKT1), tumour necrosis factor (TNF), interleukin-6 (IL6), caspase-3 (CASP3) and tumour suppressor protein (TP53) were core targets (nodes and edges). Functional annotation identified cofactor binding and coenzyme binding, and 20 significantly enriched pathways. Active compounds of EJSW were successfully docked with ITP targets. Tumour necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β) were upregulated in ITP patients, vascular endothelial growth factor A (VEGF-A) and vascular endothelial growth factor D (VEGF-D) were downregulated, and EJSW treatment reversed these trends. EJSW may regulate key ITP targets based on the in silico analyses, and protect vascular integrity through AGE-RAGE signalling, complement and coagulation cascades, and VEGF signalling by downregulating TNF-α, IL-1β and other inflammatory factors.

目的:挖掘整理中药治疗免疫性血小板减少症的相关文献,为中药治疗免疫性血小板减少症提供治疗和科研思路.方法:分别在中国知网、万方数据知识服务平台、维普期刊资源整合服务平台进行高级检索,采用Bibexcel软件提取文献关键词,使用VOSviewer软件绘制关键词共现图谱.结果:从经典中药复方角度,中药治疗免疫性血小板减少症以益气养血、清热凉血为核心,注意和解少阳的应用,代表方剂有归脾汤、犀角地黄汤、茜根散、小柴胡汤等;从现代中药复方角度,以补益、凉血、活血为原则,但研究较为分散,出现频数较高的方剂有紫癜汤、生血散、益肾活血方等;从单味中药角度,以收敛止血和清热凉血为主导,核心药物有仙鹤草、水牛角、墨旱莲等.结论:中药复方治疗免疫性血小板减少症主要从补法、清法、和法入手,其中补法以健脾益气为主,清法需注意辨别热之虚实,和法以扶正达邪;单味中药治疗,需注意收敛止血和凉血止血中药的应用.

目的 观察补肾填精方联合西药治疗再生障碍性贫血(AA)的临床疗效,分析治疗有效患者的临床特征.方法 选取2018年9月-2021年3月中国中医科学院附属西苑医院、中国中医科学院广安门医院等19家医院的AA患者187例,在西药治疗基础上予补肾填精方免煎速溶颗粒,3个月为1个疗程,连续服用2个疗程,观察患者临床疗效,分析基本痊愈、缓解及明显进步患者的临床因素特点.结果 治疗过程中脱落23例、剔除3例.基本痊愈6例(3.7％),缓解28例(17.5％),明显进步125例(77.6％),总有效率为98.8％(159/161).一般资料分析显示,男性、慢性再生障碍性贫血(CAA)、无合并病者,补肾填精方联合西药治疗更易获得疗效(P<0.05).血常规分析显示,治疗前血红蛋白(HGB)≥40 g/L且数值越高、血小板(PLT)≥10×109/L且数值越高,补肾填精方联合西药治疗AA易获得疗效(P<0.05).骨穿结果分析显示,治疗前有骨髓小粒或有核细胞增生低下更易获效(P<0.05).多因素Logistic回归分析显示,治疗前HGB越高,补肾填精方联合西药治疗AA疗效越好.结论 补肾填精方联合西药治疗AA疗效显著,男性、CAA、无合并病,HGB≥40 g/L且数值越高、PLT≥10×109/L且数值越高,有骨髓小粒或有核细胞增生低下者采用补肾填精方联合西药治疗更易取得疗效.

不久前,32岁的小李来门诊看病,说自己"乏力、食欲差,头发也越来越少".因 自身从事教育工作,自觉与工作压力相关,但停止工作后症状并未改善.详细询问后发现,这种情况从青春期就开始了,且患者从小挑食.又完善了血常规、血铁三项、贫血两项等相关检查后,诊断为"缺铁性贫血".

目的 比较补肾生血法、益气养血法联合基础西药治疗再生障碍性贫血的临床有效性及安全性.方法 采用前瞻、随机、双盲、安慰剂对照、多中心研究方法.以分层区组随机法将患者分为补肾生血组、益气养血组、对照组,中药治疗分别予补肾填精颗粒、补益气血颗粒、安慰剂(半量补肾填精颗粒),均联合口服环孢素A及雄激素.3个月为1个疗程,连续观察两个疗程治疗前后的血常规[包括白细胞计数(WBC)、血红蛋白含量(HGB)、血小板计数(PLT)、中性粒细胞计数(ANC)]、输血情况、中医证候积分、生活质量评分、安全性指标,并记录不良事件,治疗结束后1年进行随访并评定疗效.结果 共纳入585例,剔除18例,进入FAS总病例数567例,其中补肾生血组184例、益气养血组191例和对照组192例,因失访共脱落75例.补肾生血组总有效率(86.4％)明显优于益气养血组(78.0％)与对照组(72.9％,P＜0.001).各组治疗后HGB、PLT、WBC均升高(P＜0.05),尤以补肾生血组最佳(P＜0.05);补肾生血组治疗后及随访时HGB明显高于益气养血组与对照组(P＜0.05),治疗后益气养血组HGB高于对照组(P＜0.05);补肾生血组随访时PLT明显高于其余两组(P＜0.001);各组治疗后及随访时WBC均升高(P＜0.05).各组治疗后ANC均下降(P＜0.05),但补肾生血组与益气养血组随访时ANC均有回升(P＜0.001),而对照组ANC持续下降(P＜0.001).各组输血情况均有改善(P＜0.05),其中补肾生血组患者输血人数最早清零(P＜0.05);各组中医证候总积分均降低,生活质量评分均提高(P＜0.05).观察期间均未出现与治疗相关的严重不良事件.结论 补肾生血法、益气养血法联合西药治疗再生障碍性贫血疗效确切,安全性良好,可有效降低中医证候评分并提高生活质量评分,其中补肾生血法疗效更佳.

A systematic review of the efficacy and safety of Jianpi Yiqi combined with glucocorticoids in the treatment of immune thrombocytopenic purpura. Randomized controlled trial of Jianpi Yiqi therapy combined with glucocorticoid therapy for immune thrombocytopenic purpura was retrieved without any restrictions on blindness and language. Randomized controlled trial that met the inclusion criteria were screened, and the Revman5.3 software was used for meta-analysis. A total of 27 articles were included with 1716 cases. The results of the meta-analysis showed that in terms of the effective rate of Western medicine, the effect of Jianpi Yiqi combined with glucocorticoid therapy were significantly better than that of glucocorticoid therapy alone, with a statistically significant difference (p<0.0001). The combination of traditional Chinese and Western medicine is better than hormone therapy in improving the efficiency of traditional Chinese medicine, platelet count, syndrome score, interleukin-10 and cluster of differentiation 4/cluster of differentiation 8 levels. The effect of Jianpi Yiqi combined with glucocorticoid in the treatment of immune thrombocytopenic purpura is better than that of glucocorticoid alone, which is worthy of further study and promotion.

前段时间,血液科门诊来了一个因"发现颈部淋巴结肿大1月余"前来就诊的20多岁小伙子.起初他无意中摸到颈部有肿块,不痛不痒,也没在意.过了一个多月后,肿块不但没消散,反而比之前更大了,而且摸起来跟橡皮一样坚实.不放心遂来就医,经过一番查体和B超、穿刺活检等检查,确诊为"淋巴瘤".

目的 探究再障膏方对再生障碍性贫血小鼠免疫细胞、脾脏形态及功能的影响.方法 将SPF级BALB/c雌性小鼠随机分为空白组8只、模型组18只、中西医结合组10只、再障膏方组10只、环孢素组10只.除空白组外,其余组均连续灌胃5d白消安片悬液建立再生障碍性贫血模型.自实验第11天开始,模型组与空白组灌胃无菌注射用水0.1 mL,早晚各1次;再障膏方组早上灌胃820 mg/mL再障膏方溶液0.1 mL,晚上灌胃无菌注射用水0.1 mL;环孢素组早上灌胃无菌注射用水0.1 mL,晚上灌胃5 mg/mL环孢素溶液0.1 mL;中西医结合组早上灌胃820 mg/mL再障膏方溶液0.1 mL,晚上灌胃5 mg/mL环孢素溶液0.1 mL.各组均连续干预10 d后摘眼球取血,检测外周血细胞,采用流式细胞仪检测外周血Treg、Th17细胞占比;摘取脾脏,计算脾脏指数,HE染色观察脾脏形态.结果 模型组外周血中WBC、RBC、Hb、Plt及Treg细胞占比、Treg/Th17均明显低于空白组(P均<0.05),Th17细胞占比明显高于空白组(P<0.05);中西医结合组WBC、RBC、Hb、Plt、Treg细胞占比、Treg/Th17和再障膏方组Plt及环孢素组RBC、Plt均明显高于模型组(P均<0.05);中西医结合组Plt明显高于环孢素组(P<0.05),WBC、Plt均明显高于再障膏方组(P均<0.05).实验第11天和实验第21天,中西医结合组、再障膏方组、环孢素组小鼠体重比较差异均无统计学意义(P均>0.05),均明显低于空白组(P均<0.05);模型组小鼠脾脏指数明显低于空白组(P<0.05),中西医结合组、环孢素组脾脏指数明显高于模型组和再障膏方组(P均<0.05),再障膏方组与模型组比较差异无统计学意义(P>0.05).HE染色显示模型组小鼠红白髓界限消失,中西医结合组红白髓界基本可见,再障膏方组红白髓界限模糊,环孢素组红白髓界限隐约可见.结论 环孢素联合再障膏方较单用环孢素能更好地促进再生障碍性贫血小鼠血象恢复,改善Treg/Th17细胞比值异常及脾脏功能.

目的 系统性评价补肾法联合环孢素+雄激素方案治疗慢性再生障碍性贫血(CAA)的安全性和有效性,为临床应用和深入研究提供基础.方法 检索补肾法联合环孢素+雄激素治疗CAA的随机对照试验(RCTs),无盲法及语言等限制;筛选符合纳入标准的RCTs,依据Jadad评分法对文献进行质量评价,剔除3分以下的文献纳入最后研究,并采用Revman 5.3软件进行Meta分析.结果 共纳入9篇文献,Jadad评分均为3分,纳入病例共494名.Meta分析:补肾法中药联合环孢素A+雄激素治疗CAA在疗效、中医证候积分、外周血象方面效果优于单纯西药治疗,同时在减轻环孢素及雄激素不良反应方面具有明显的优势(P<0.0001),差异具有统计学意义.结论 补肾法联合环孢素A+雄激素治疗CAA的效果及安全性优于单纯应用环孢素A+雄激素.

目的:验证健脾益气摄血方缓解ITP乏力症状与改善线粒体功能的相关性.方法:通过被动免疫造模法建立ITP小鼠模型,分为正常组、模型组、强的松组、健脾益气摄血(JPYQSX)中、高剂量组.通过光谱法检测小鼠脾脏组织活性氧含量;通过实时荧光定量PCR(qPCR)检测线粒体DNA相对拷贝数;通过免疫荧光法检测结肠ATP含量.结果:与正常组比较,模型组(P<0.01)、强的松组(P<0.05)、健脾益气摄血各剂量组(P<0.01)小鼠脾脏组织ROS含量增多,脾脏组织线粒体DNA相对拷贝数明显下调(P<0.01),结肠组织ATP含量明显下调(P<0.01);与模型组比较,强的松组、健脾益气摄血各剂量组小鼠脾脏组织ROS含量减少,脾脏组织线粒体DNA相对拷贝数比较无统计学意义(P>0.05),结肠组织ATP含量均显著升高(P<0.01).结论:健脾益气摄血方可通过改善线粒体功能来有效缓解ITP乏力症状.