王佳 褚雨霆 王冲 侯丽 郎海燕 陈科 陈信义 张雅月

摘要 目的：观察“从脾论治方”对原发免疫性血小板减少症（ITP）小鼠血管活性因子的影响，探讨“从脾论治方”的止血效应机制。方法：以被动型免疫造模法建立ITP小鼠模型，以泼尼松、归脾汤、健脾益气方、健脾益气摄血方为干预药物，以ELISA检测模型小鼠血清血管内皮素-1（ET-1）、血栓素A2（TXA2）、血管性血友病因子（vWF）、血管内皮细胞黏附分子-1（VCAM-1）、前列腺素（PG）、前列环素（PGI2）、一氧化氮（NO）、一氧化氮合酶3（NOS3）、血栓调节蛋白（TM）水平。结果：1）升血小板疗效：注射APS后第15天（给药第8天），模型对照组小鼠外周血血小板计数（PLT）仍显著低于正常对照组，而各给药组小鼠外周血PLT与正常对照组比较差异无统计学意义（P>0.05），并且明顯高于模型对照组。2）止血疗效：注射APS后各组小鼠均有不同程度出血倾向，药物干预第6天及第8天，各观察组出血等级明显低于模型对照组。3）血管促凝活性因子：实验各组VCAM-1水平显著低于正常对照组，差异有统计学意义（P<0.05）;健脾益气组和归脾汤组VCAM-1水平均显著高于模型对照组和泼尼松组，健脾益气摄血组VCAM-1水平明显高于泼尼松组，差异有统计学意义（P<0.05）。4）血管抗凝活性因子：实验各组TM水平明显低于正常对照组，健脾益气摄血组TM水平显著低于模型对照组，差异有统计学意义（P<0.05）。结论：“从脾论治”方可以升高ITP模型小鼠外周血PLT，降低出血分级，并且可以通过上调VCAM-1、下调TM检测值调节促凝与抗凝活性因子的动态平衡。

关键词 从脾论治;原发免疫性血小板减少症;血管活性因子;血管促凝活性因子;血管抗凝活性因子

Abstract Objective：To observe the effect of “Congpi Lunzhi Formula” on vasoactive factors in ITP mice，and to explore the hemostatic effect mechanism of “Congpi Lunzhi Formula”.Methods：The ITP mice immune model was established by means of passive immunization.Prednisone，Guipi Decoction，Jianpi Yiqi Decoction，Jianpi Yiqi Shexue Formula were used as intervention drugs，and serum ET-1，NO，NOS3，TXA2，PGI2，vWF，VCAM-1 of model mice were detected by ELISA and TM levels were detected by ELISA.Results：1）Increasing efficacy of platelet：On the 15th day after APS injection（the 8th day of administration），the PLT count in the peripheral blood of the model control group was still significantly lower than that of the normal control group，while the peripheral blood PLT of the mice in the model control group was lower than the normal control group.However，the peripheral blood PLT of mice in each administration group had no statistical difference compared with the normal control group，and was significantly higher than the model control group.2）Hemostatic effect：After injection of APS，mice in each group have different degrees of bleeding tendency.On the 6th and 8th day of drug intervention，the bleeding level of each experimental group was significantly lower than that of the model control group.3）Vascular procoagulant activity factors：the levels of VCAM-1 in each experimental group were significantly lower than those in the normal control group; the levels of VCAM-1 in the Jianpi Yiqi group and the Guipi Decoction group were significantly higher than those in the model control group and the prednisone group.The level of VCAM-1 in the Jianpi Yiqi Shexue group was significantly higher than that in the prednisone group.4）Vascular anticoagulant activity factors：the TM levels of each experimental group were significantly lower than those of the normal control group，and the TM levels of Jianpi Yiqi Shexue group were significantly lower than the model control group.Conclusion：Treatment from spleen could improve PLT count of ITP model mice，degrade the bleeding scale.Moreover，it can upregulate VCAM-1，downregulate TM，keep the dynamic balance of coagulant and anticoagulant factors.

Keywords Treatment from spleen; Immune thrombocytopenic purpura; Vasoactive factors; Vascular coagulant active element; Vascular anticoagulant active element

中图分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.11.011

原发免疫性血小板减少症（Immune Thrombocytopenic Purpura，ITP）以外周血小板破坏增多，以及骨髓生成血小板减少为主要病理表现，是临床常见的血液系统出血性疾病。目前对于ITP发病机制尚不完全清晰，公认的发病机制系多重因素导致的自身免疫功能紊乱[1-2]。根据中医学理论，结合慢性ITP的临床特征，其发病系脾气虚弱，不能正常发挥统摄血液的功能所致[3]。因……