中医药治疗免疫性血小板减少性紫癜优势与问题分析.docVIP

  中医药治疗免疫性血小板减少性紫癜优势 与问题分析# 李天天，褚雨霆，刘庆，陈信义** 5 10 15 20 25 30 35 40 （北京中医药大学东直门医院血液肿瘤科，北京 100700） 摘要：免疫性血小板减少性紫癜是一种由免疫介导的血小板减少综合征。临床以出血及外周 血小板减少，骨髓巨核细胞数正常或伴有成熟障碍为主要表现的常见出血性疾病。发病机制 主要是体液和细胞免疫介导的血小板过度破坏以及巨核细胞数量和质量异常而导致的血小 板生成不足。中医学的整体观念和辨证论治是 ITP 治疗的基本法则，辨证治疗能够体现个体 化，能够量体裁衣的为每一位患者提供身心受益的治疗方法或方药。单方治疗 ITP 也有一定 疗效。但也存在以下问题：成年患者多属于 CITP，其病程漫长，迁延难愈。脾胃处于虚 弱状态，长期服用汤药的依从性较差。各家对 ITP 病机和证候认识的差别，用药也有明显 差异，导致临床疗效的重现性较差，不能形成具有循证医学证据的重大科技成果。缺乏随 机对照、多中心协作的临床试验设计方案，难以对其治疗结果给出肯定的结论。用药随意 性较大，难以形成具有肯定治疗效果的有效处方，给新药研发带来相当难度。批次药材质 量对治疗结果也会带来影响。 关键词：中西医结合临床；免疫性血小板减少性紫癜；中医药 中图分类号：R25 Analysis of Traditional Chinese Medicine Method in ITP Treatment LI Tiantian, CHU Yuting, LIU Qing, CHEN Xinyi (Hemato-oncology Department,Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine,Beijing 100700) Abstract: Immune Thrombocytopenic Purpura (ITP) is a common hematologic disease with the feature of bleeding, peripheral thrombocytopenia and bone marrow megakaryocytes changed in numbers and morphologically. The mechanism is an autoimmune disorder due to accelerated platelet destruction and impaired platelet production. The basic principle in treating ITP is wholism and treatment by differentiation of syndromes. Individuation of dialectical treatment can provide efficient therapy and herbs for every patient. Simple prescription also has certain effect in treatment. There presents following problems: Chronic Immune Thrombocytopenic Purpura (CITP) is more common in the adult patients and always be a long course and intractable disease. This resulted in weakness of the spleen and the stomach and poor compliances. With the different views of pathogenesis and characteristics of clinical TCM syndromes, the herbs used in treatment has obvious distinction. Because of limited reproducibility in clinical efficacy, the great achievement based on evidence-based medicine has not been got. The lack of multi-centered and randomized controlled clinical trial makes it difficult to get the positive c