Hu Huijin, Chen Tao, Liu Wenbin, Shen Yiping, Li Qiushuang, Zhou Yuhong, Ye Baodong, Wu Dijiong
Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Department of Hematology, Xiaoshan Traditional Chinese Medical Hospital, Hangzhou, Zhejiang, People's Republic of China.
J Blood Med. 2021 Nov 13;12:975-989. doi: 10.2147/JBM.S332171. eCollection 2021.
To better understanding and differentiation of traditional Chinese medicine (TCM) syndromes in severe aplastic anemia (SAA) patients undergoing hematopoietic stem cell transplantation (Allo-HSCT) and their correlation with iron metabolism, cAMP/cGMP, 17-OH-CS and thyroxine.
Eighteen patients with SAA who underwent HSCT were enrolled. The syndrome was evaluated before conditioning and days after stem cell reinfusion (-10d, -1d, +7d, +30d, +60d, and +90d). The correlation of TCM syndrome (Yin, Yang, and stasis) to cyclic nucleotides, 17-OH-CS, thyroxine, and iron metabolism were analyzed and compared to data from normal subjects.
More "Yin deficiency" (n=11, 11/18) syndrome was observed before HSCT, and nearly 61% was complicated with "blood stasis". After conditioning, the proportion of "kidney Yin and Yang deficiency" increased to 61.6%. Fourteen days after HSCT, the syndrome developed into "Spleen-Kidney Yang Deficiency," and the stasis score decreased. On +90day, majority patients were diagnosed with "Kidney Yang Deficiency" (35.7%) or "Spleen-Kidney Yang Deficiency" (28.6%), and 88.9% were diagnosed without stasis. The correlation analysis showed that cGMP might represent "Deficient Yang" as well as low total triiodothyronine (T3) and free T3 (FT3). There was also a positive relation between labile plasma iron (LPI), hepcidin, soluble transferrin receptor (sTfR), and "Yin deficiency", and the last two factors, along with marrow nitric oxide synthase were also positively related to "Stasis" syndrome.
During HSCT, the syndrome evolved from "kidney Yin and Yang deficiency" to "kidney Yang deficiency" or "spleen-kidney Yang deficiency", and the "stasis" along with "Yin deficiency" syndromes were quickly relieved within 90 days. The changes of cyclic nucleotides, 17-OH-CS, thyroxine, and iron metabolism indexes can be applied for better differentiation of TCM syndrome.
更好地了解和鉴别接受造血干细胞移植（Allo-HSCT）的重型再生障碍性贫血（SAA）患者的中医证候及其与铁代谢、环磷酸腺苷/环磷酸鸟苷、17-羟皮质类固醇和甲状腺素的相关性。
纳入18例接受HSCT的SAA患者。在预处理前以及干细胞回输后第-10天、-1天、+7天、+30天、+60天和+90天对证候进行评估。分析中医证候（阴虚、阳虚、血瘀）与环核苷酸、17-羟皮质类固醇、甲状腺素和铁代谢的相关性，并与正常受试者的数据进行比较。
HSCT前观察到更多“阴虚”（n=11，11/18）证候，近61%合并“血瘀”。预处理后，“肾阴阳两虚”比例增至61.6%。HSCT后14天，证候发展为“脾肾阳虚”，血瘀评分降低。在+90天时，大多数患者诊断为“肾阳虚”（35.7%）或“脾肾阳虚”（28.6%），88.9%诊断为无血瘀。相关性分析表明，环磷酸鸟苷可能代表“阳虚”以及总三碘甲状腺原氨酸（T3）和游离T3（FT3）降低。不稳定血浆铁（LPI）、铁调素、可溶性转铁蛋白受体（sTfR）与“阴虚”之间也存在正相关，后两个因素以及骨髓一氧化氮合酶也与“血瘀”证候呈正相关。
HSCT期间，证候从“肾阴阳两虚”演变为“肾阳虚”或“脾肾阳虚”，“血瘀”以及“阴虚”证候在90天内迅速缓解。环核苷酸、17-羟皮质类固醇、甲状腺素和铁代谢指标的变化可用于更好地鉴别中医证候。
