Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag

LIU Qi; SHEN Yingying; LI Yuzhu; WANG Jun; GAO Yanting; SHEN Yiping; YE Baodong; ZHOU Yuhong; WU Dijiong

doi:10.3969/j.issn.1006-2157.2023.09.020

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Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag

Hematology and Oncology | 更新时间：2023-10-09

- Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag
- Journal of Beijing University of Traditional Chinese Medicine Vol. 46, Issue 9, Pages: 1325-1332(2023)
- 作者机构：
  
  1.浙江中医药大学附属第一医院(浙江省中医院)血液科　杭州　310006
  2.浙江中医药大学第一临床医学院
- 作者简介：
  
  A/Prof. WU Dijiong, Associate Chief Physician, Master’s Supervisor. First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54, Youdian Road, Hangzhou 310006. E-mail: wudijiong@zcmu.edu.cn
- 基金信息：
  
  National Natural Science Foundation of China(81603573);Special Research Project of Clinical Medicine of Zhejiang Medical Association(2022ZYC-Z25);Zhejiang Provincial Fund for Outstanding Young Talents of Traditional Chinese Medicine(2015ZQ012);Project of Academic Inheritance Studio of Famous and Aged Chinese Medicine Experts in Zhejiang Province(GZS2021022)
- DOI：10.3969/j.issn.1006-2157.2023.09.020
  CLC： R255.7
- Received：12 March 2023，
  
  Published Online：10 July 2023，
  
  Published：30 September 2023
- 稿件说明：
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LIU Qi, SHEN Yingying, LI Yuzhu, et al. Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(9): 1325-1332.
DOI：

LIU Qi, SHEN Yingying, LI Yuzhu, et al. Immunological characteristics of different TCM patterns in primary immune thrombocytopenia patients with failed first-line treatment and response to eltrombopag[J]. Journal of beijing university of traditional chinese medicine, 2023, 46(9): 1325-1332. DOI： 10.3969/j.issn.1006-2157.2023.09.020.

摘要

目的

研究一线治疗失败的原发免疫性血小板减少症(ITP)不同中医证候患者的免疫学特征及对艾曲泊帕的疗效反应差异。

方法

收集2018年1月—2021年9月在浙江中医药大学附属第一医院血液科就诊的一线治疗失败后接受艾曲泊帕治疗的ITP患者。共纳入58例患者，按中医证候分为气不摄血证组(22例)、瘀血内阻证组(9例)、血热妄行证组(13例)和阴虚内热证组(14例)。对各组患者的免疫指标(淋巴细胞亚群、免疫球蛋白及补体)特征进行比较，并评估各组接受艾曲泊帕的疗效反应。

结果

接受艾曲泊帕治疗前，瘀血内阻证组自然杀伤细胞(NK)比例(16.91%±7.24%)及计数[(230.33±188.35)×10

－1

]均高于气不摄血证组[9.76%±6.33%，(109.38±76.60)×10

－1

]及血热妄行证组[5.82%±3.70%，(52.50±40.91)×10

－1

](均

0.05)，而各组间免疫球蛋白及补体水平比较，差异均无统计学意义。气不摄血证组、瘀血内阻证组、血热妄行证组和阴虚内热证组患者艾曲泊帕治疗总体有效率分别为68.2%(15/22)、22.2%(2/9)、61.5%(8/13)和78.6%(11/14)，其中瘀血内阻证组与阴虚内热证组、气不摄血证组疗效的差异均有统计学意义(

0.05)。

结论

患者外周血NK比例可能参与了ITP不同中医证候患者对艾曲泊帕疗效反应的差异，高NK水平在ITP瘀血内阻证患者中较为多见，预期疗效反应较低。

Abstract

Objective

We aimed to evaluate the immunological characteristics of different TCM patterns of primary immune thrombocytopenia(ITP) patients with failed first-line treatment and the response to eltrombopag.

Methods

From January

2018 to September

2021

the clinical data of 58 first-line failed ITP patients treated with eltrombopag were enrolled at First Affiliated Hospital of Zhejiang Chinese Medical University. Enrolled patients were divided into four groups based on TCM patterns

and their immune indicators

including lymphocyte subsets

immunoglobulin levels

and complement factors

with the efficacy of eltrombopag compared. Patients were classified into pattern of qi failing to control blood (22 cases)

pattern of internal blockade of static blood(9 cases)

pattern of bleeding due to blood heat(13 cases)

and pattern of endogenous heat due to yin deficiency(14 cases) group based on TCM patterns.

Results

Comparative analysis of immune indexes of ITP patients with different TCM patterns showed that the percentage and absolute count of NK cells in the pattern of internal blockade of static blood group(16.91%±7.24%

(230.33±188.35)×10

-1

) were significantly higher than those in the pattern of qi failing to control blood group(9.76%±6.33%

(109.38± 76.60)×10

-1

) and the pattern of bleeding due to blood heat group(5.82%±3.70%

(52.50±40.91)×10

-1

)(

0.05). However

there was no statistical difference in the levels of immunoglobulin and complement factors among all the groups. Comparison of the efficacy response of patients with different TCM patterns to eltrombopag showed that the effective rates in the pattern of qi failing to control blood

pattern of internal blockade of static blood

pattern of bleeding due to blood heat

and pattern of endogenous heat due to yin deficiency group were 68.2%(15/22)

22.2%(2/9)

61.5%(8/13)

and 78.6%(11/14)

respectively; the curative effect in the pattern of internal blockade of static blood group was different from that in the pattern of endogenous heat due to yin deficiency and pattern of qi failing to control blood group(

0.05).

Conclusion

The proportion of NK cells in patients’ peripheral blood may be involved in the difference of therapeutic response to eltrombopag in ITP patients with different TCM patterns. High NK cell counts are more common in ITP patients of the pattern of internal blockade of static blood group

which is related to the lower expected therapeutic response to eltrombopag.

关键词

Keywords

references

LAMBERT MP , GERNSHEIMER TB . Clinical updates in adult immune thrombocytopenia [J]. Blood , 2017 , 129 ( 21 ): 2829 － 2835 .

白玉盛，李晓征，黄志惠，等 . 中医证型对原发免疫性血小板减少症患者接受激素治疗反应的评估 [J]. 重庆医学， 2019 , 48 ( 8 ): 1309 － 1311 .

王永，杨茜，杜青容，等 . 原发免疫性血小板减少症的中医证型与免疫学指标相关性研究进展 [J]. 新中医， 2017 , 49 ( 11 ): 130 － 133 .

中华医学会血液学分会血栓与止血学组 . 成人原发免疫性血小板减少症诊断与治疗中国指南(2020年版) [J]. 中华血液学杂志， 2021 , 41 ( 8 ): 617 － 623 .

中华中医药学会 . 中医内科常见病诊疗指南　西医疾病部分 [M]. 北京：中国中医药出版社， 2008 ： 212 .

陈信义，麻柔，李冬云 . 规范常见血液病中医病名建议 [J]. 中国中西医结合杂志， 2009 , 29 ( 11 ): 1040 － 1041 .

林琳，杨冉，姚浩，等 . 成人原发免疫性血小板减少症中医体质类型临床研究 [J]. 中华中医药杂志， 2021 , 36 ( 1 ): 520 － 522 .

全日城，麻柔 . 麻柔辨证施治慢性免疫性血小板减少性紫癜经验 [J]. 北京中医药， 2010 , 29 ( 4 ): 260 － 261 .

张敏，张子彦，徐瑞琴，等 . 成人特发性血小板减少性紫癜患者糖皮质激素抵抗辨证分型与临床指标相关性分析 [J]. 山东中医杂志， 2018 , 37 ( 2 ): 115 － 119 .

白玉盛，李晓征，马西虎，等 . 原发免疫性血小板减少症同病异证分布规律的研究 [J]. 实用中医内科杂志， 2020 , 34 ( 11 ): 4 － 6 .

丁晓庆，苏伟 . 免疫性血小板减少性紫癜中医证候分析 [J]. 北京中医药大学学报(中医临床版) , 2011 , 18 ( 6 ): 20 － 22 .

李志静 . T淋巴细胞亚群(CD4 ＋，CD8 ＋，CD4 ＋ /CD8 ＋ )与免疫性血小板减少性紫癜中医证型相关性研究 [J]. 实用中医内科杂志， 2014 , 28 ( 6 ): 10 － 12 .

李晓征，白玉盛，王永，等 . 不同证型原发免疫性血小板减少症患者淋巴细胞亚群表达特征 [J]. 中医杂志， 2017 , 58 ( 13 ): 1126 － 1129 .

BAO W , BUSSEL JB , HECK S , et al . Improved regulatory T-cell activity in patients with chronic immune thrombocytopenia treated with thrombopoietic agents [J]. Blood , 2010 , 116 ( 22 ): 4639 － 4645 .

LI XJ , ZHONG H , BAO WL , et al . Defective regulatory B-cell compartment in patients with immune thrombocytopenia [J]. Blood , 2012 , 120 ( 16 ): 3318 － 3325 .

李林森，田金洲，蔡艺灵，等 . 血瘀证生物学基础研究进展 [J]. 山东中医杂志， 2010 , 29 ( 12 ): 863 － 865 .

刘齐烨，葛繁梅 . 淋巴细胞亚群异常在原发免疫性血小板减少症发病机制中的研究进展 [J]. 分子影像学杂志， 2017 , 40 ( 4 ): 489 － 493 .

李蒙，吴玖斌，郭秀伟，等 . 晚期原发性肺癌血瘀证评分与临床指标相关性研究 [J]. 中国中西医结合杂志， 2018 , 38 ( 2 ): 168 － 172 .

MCMILLAN R , TANI P , MILLARD F , et al . Platelet-associated and plasma anti-glycoprotein autoantibodies in chronic ITP [J]. Blood , 1987 , 70 ( 4 ): 1040 － 1045 .

WANG SG , LIU FH , ZHAO HG . Eosinophil Granulocyte and NK Cell-Mediated Platelet Destruction in Immune Thrombocytopenia [J]. Indian J Hematol Blood Transfus , 2018 , 34 ( 1 ): 121 － 124 .

EBBO M , AUDONNET S , GRADOS A , et al . NK cell compartment in the peripheral blood and spleen in adult patients with primary immune thrombocytopenia [J]. Clin Immunol , 2017 , 177 : 18 － 28 .

LIU Q , SHEN YY , LI YZ , et al . Efficiency and safety of eltrombopag for multi-line failed Chinese patients with immune thrombocytopenia: cases with decreased megakaryocyte response well from single-center experience [J]. Immunol Res , 2022 , 70 ( 1 ): 67 － 74 .

PEERSCHKE EI , PANICKER S , BUSSEL J . Classical complement pathway activation in immune thrombocytopenia purpura: inhibition by a novel C1s inhibitor [J]. Br J Haematol , 2016 , 173 ( 6 ): 942 － 945 .

NAJAOUI A , BAKCHOUL T , STOY J , et al . Autoantibody-mediated complement activation on platelets is a common finding in patients with immune thrombocytopenic purpura(ITP) [J]. Eur J Haematol , 2012 , 88 ( 2 ): 167 － 174 .

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