赵琳 邱仲川 陈珮 黄中迪 胡晓莹 朱小勤 瞿玮颖

摘要：目的 观察复方参鹿颗粒联合西药治疗肾阳虚型再生障碍性贫血（AA）临床疗效及对CD4+T细胞亚群的影响，探讨其作用机制。方法 将40例AA患者随机分为治疗组和对照组各20例。治疗组予复方参鹿颗粒联合西药治疗，对照组单用西药治疗。疗程均为6个月，随访1年以上。观察2组临床疗效及治疗前后外周血CD4+T细胞亚群变化。结果 治疗组临床疗效优于对照组，差异有统计学意义（P<0.05）。治疗后2组血细胞计数均较治疗前改善，差异有统计学意义（P<0.05，P<0.01）。治疗组治疗后红细胞计数、血红蛋白含量均高于对照组，差异有统计学意义（P<0.05）。与治疗前比较，治疗组治疗后CD4+CD25+细胞/CD4+细胞、CD4+CD25+FoxP3+细胞/CD4+CD25+细胞比例升高，Th1、Th2细胞比例降低，差异有统计学意义（P<0.05）；对照组治疗后仅Th2细胞比例降低，差异有统计学意义（P<0.05）。结论 复方参鹿颗粒可提高肾阳虚型AA治疗效果，其机制可能与减少Th1细胞数量、增加CD4+CD25+调节性T细胞数量、提高其FoxP3的表达有关。

关键词：复方参鹿颗粒；再生障碍性贫血；CD4+T细胞亚群

中图分类号：R259.565 文献标识码：A 文章编号：1005-5304（2016）05-0020-04

Efficacy Observation of Fufang Shenlu Granule for Kidney-yang Deficiency Aplastic Anemia and Its Effects on CD4+ T Lymphocyte Subsets ZHAO Lin， QIU Zhong-chuan， CHEN Pei， HUANG Zhong-di， HU Xiao-ying， ZHU Xiao-qin， QU Wei-ying （Shuguang Hospital Affiliated to Shanghai University of TCM， Shanghai 200021， China）

Abstract： Objective To observe the clinical efficacy of Fufang Shenlu Granule for kidney-yang deficiency aplastic anemia （AA） and its effects on CD4+ T lymphocyte subsets， and explore its mechanism. Methods Forty AA patients were randomly divided into treatment group and control group， 20 cases in each group. The treatment group was treated with Fufang Shenlu Granule combined with conventional western medicine therapy， while the control group was only treated with conventional western medicine therapy. The treatment lasted for 6 months， and follow-up visits lasted for at least one year. The clinical efficacy and T lymphocyte subsets ratio changes before and after treatment in the two groups were observed. Results The clinical efficacy of treatment group was better than that of control group （P<0.05）. After treatment， the blood cell counts of the two groups were improved than those of before treatment （P<0.05， P<0.01）. After treatment， the red blood cell count and hemoglobin of treatment group were higher than those of control group （P<0.05）. Compared with the data before treatment in treatment group， the ratio of CD4+CD25+ cells in all CD4+ cells， and the ratio of CD4+CD25+FoxP3+ cells in all CD4+CD25+ cells increased （P<0.05）； the ratio of Th1 and Th2 cells in all CD3+CD4+ decreased （P<0.05）. The ratio of Th2 cells was lower than that before treatment in the control group （P<0.05）. Conclusion Fufang Shenlu Granule can enhance the treatment efficiency of AA with kidney-yang deficiency syndrome. The mechanism may be related to the decrease of Th1 cells， the increase of CD4+CD25+Tregs and their FoxP3 expression.

Key words： Fufang Shenlu Granule； aplastic anemia； CD4+ T lymphocytes subsets

再生障碍性贫血（aplastic anemia，AA）是免疫介导的以全血细胞减少为主要临床表现的骨髓衰竭性疾病。既往研究认为，CD8+T细胞介导的造血干细胞免疫损伤是AA发生的病理基础[1]。近年来研究发现，CD4+T细胞亚群在AA发病中发挥更重要的作用[2-3]。AA为临床常见的难治性血液系统疾病，中西医结合治疗该病的效果已得到认可。复方参鹿颗粒为本院院内制剂，该方重用温肾益髓药物，临床用于AA治疗20余年。本研究采用随机对照试验，进一步验证复方参鹿颗粒联合西药治疗AA疗效的可靠性，观察其对CD4+T细胞亚群的影响，探讨作用机制。

1 资料与方法

1.1 一般资料

经本院医学伦理委员会批准，选择2012年5月-2014年12月在本院血液科就诊的AA患者40例。采用随机数字表将入组患者分为治疗组和对照组各20例。治疗组男10例，女10例；年龄18～70岁，平均（47.25±12.80）岁；病程最短3个月，最长30年，平均（1.82±1.25）年；初治17例，复治3例；重型AA 7例，轻型AA 13例。对照组男11例，女9例；……