Clinical Effect of Bushen Shengxue Prescription on Chronic Aplastic Anemia and Its Effect on T Cell Subsets and Expression of T-bet and GATA3 / 中国实验方剂学杂志

ObjectiveTo investigate the efficacy of Bushen Shengxue prescription and Yiqi Yangxue prescription in the treatment of chronic aplastic anemia and the effect on T cell subsets and the expression of T-box expressed in T cells （T-bet） and GATA binding protein 3 （GATA3）. MethodA total of 585 patients with chronic aplastic anemia who were treated in 19 hospitals in China from May 2018 to June 2021 were enrolled. With the prospective， double-blind and randomized control methods， the patients were randomized into three groups： kidney deficiency group， Qi and blood deficiency group， and control group. The three groups were respectively treated with Bushen Shengxue prescription granule， Yiqi Yangxue prescription granule， and Placebo （half the dose of Bushen Shengxue formula granules）. In addition， all of them were given oral cyclosporin and androgen. The treatment lasted 6 months， with 3 months as a course. The blood routine indexes， T cell subsets， and fusion genes T-bet and GATA3 before and after treatment were analyzed， and the safety indexes were monitored. ResultDuring the observation， a total of 75 cases dropped out and 18 were rejected. Finally， 161 cases in the kidney deficiency group， 164 in the Qi and blood deficiency group， and 167 in the control group were included. After 6 months of treatment， the total effective rate was 98.8% （159/161） in the kidney deficiency group， which was higher than the 79.9% （131/164） in the Qi and blood deficiency group （χ2=30.135， P<0.01） and the 61.7% （103/167） in the control group （χ2=70.126， P<0.01）. The total effective rate was higher in the Qi and blood deficiency group than in the control group （χ2=13.232， P<0.01）. After treatment， the hemoglobin （HGB） content increased significantly in three groups （P<0.05） as compared with that before treatment， particularly the kidney deficiency group （P<0.01）. After treatment， the white blood cell （WBC） count and platelet （PLT） count in the kidney deficiency group and the control group increased compared with those in the Qi and blood deficiency group （P<0.01）. There was no specific difference in neutrophils （ANC） after treatment among the three groups. At the same time point， the level of T helper type 1 （Th1） cells， Th1/Th2 ratio （P<0.05）， level of CD4+， and CD4+/CD8+ ratio （P<0.05） were significantly low in the kidney deficiency group among three groups. There was no significant difference in CD19-， HLA/DR+， and CD25+ between the kidney deficiency group and the other two groups， but the T-bet of the kidney deficiency group and the control group was lower than that of the Qi and blood deficiency group （P<0.05）. ConclusionBushen Shengxue prescription exerts therapeutic effect on the aplastic anemia by improving the immunoregulatory mechanism， inhibiting the activity of immune system， modulating T cell subsets， suppressing Th1 and CD4+， and promoting bone marrow hematopoiesis. Moreover， it is safe with little side effects， which is worthy of further promotion.

Treatment of Chronic Aplastic Anemia with Chinese Patent Medicine Pai-Neng-Da Capsule () for Replacing Androgen Partially: A Clinical Multi-Center Study / 中国结合医学杂志

OBJECTIVE@#To evaluate the efficacy and safety of Pai-Neng-Da Capsule (, panaxadiol saponins component, PNDC) in combination with the cyclosporine and androgen for patients with chronic aplastic anemia (CAA).@*METHODS@#A total of 79 CAA patients was randomly divided into 2 groups by a random number table, including PCA group [43 cases, orally PNDC 320 mg/d plus cyclosporine 5 mg/(kg·d) plus andriol 80 mg/d] and CA group [36 cases, orally cyclosporine 5 mg/(kg·d) plus andriol 160 mg/d]. All patients were treated and followed-up for 6 treatment courses over 24 weeks. The complete blood counts, score of Chinese medical (CM) symptoms were assessed and urine routine, electrocardiogram, hepatic and renal function were observed for safety evaluation. Female masculinization rating scale was established according to the actual clinical manifestations to evaluate the accurate degree of masculinization in female CAA patients treated by andriol.@*RESULTS@#The effective rates were 88.1% (37/42) in the PCA group and 77.8% (28/36) in the CA group based on the standard for the therapeutic efficacy evaluation of hematopathy. There was no significant difference in the white blood cell (WBC) counts, platelet counts and hemoglobin concentration of peripheral blood between two groups after 6 months treatment. The masculinization score of female patient in the PCA group was significantly lower than the CA group (P<0.05). The mild abdominal distention was observed in 1 cases in the PCA group. In CA group, the abnormalities in the hepatic function developed in 2 cases and the renal disfunction was found in 1 case.@*CONCLUSION@#The PNDC possesses certain curative effects in the treatment of CAA without obvious side-effects and can partially replace andriol thereby to reduce the degree of masculinization [Registried at Chinese Clinical Trial Registry (ChicTR1900028153)].

Evaluation of the Efficacy of Cyclosporin A Combined with Recombined Human Erythropoietin in the Treatment of Patients with Chronic Aplastic Anemia / 中国医学科学院学报

Objective To compare the efficacy and safety of cyclosporin A(CsA)and CsA combined with recombined human erythropoietin(rhEPO)in the treatment of patients with chronic aplastic anemia(CAA).Methods Data of 79 patients with CAA treated at Department of Hematology,PUMC Hospital between January 2016 and June 2018 were collected for retrospective analysis.Forty-five patients were treated with CsA+rhEPO,and the other 34 patients with CsA alone.All the enrolled patients were treated for at least 1.5-2.0 years and followed for at least 1.0 year.The efficacy,side effects,long-term outcomes were compared between the two groups,and factors that may influence the efficacy were analyzed.Results The patients treated with CsA+rhEPO included 14 males and 31 females,with a median age of 43(19,73)years old.The median treatment duration of CsA and rhEPO was 26(12,38)and 4(3,6)months,respectively,and the median followed-up time was 24(12,42)months.The patients treated with CsA alone included 16 males and 18 females,with a median age of 36(16,85)years old.The median CsA treatment duration was 24(12,40)months and the median follow-up time was 25(12,40)months.There was no statistical difference in baseline characteristics between the two groups(all

Effect of Therapy of Tonifying Kidney,Activating Bone-marrow,and Unblocking Collaterals on Thromboelastogram Platelet Maximum Amplitude Value of Patients with Chronic Aplastic Anemia / 广州中医药大学学报

Objective To observe the therapeutic effect of therapy of tonifying kidney,activating bone-marrow, and unblocking collaterals for patients with chronic aplastic anemia (CAA), and to investigate its effect on thromboelastogram platelet maximum amplitude (Ma) value for exlporing its therapeutic mechanism. Methods Sixty CAA patients were randomized into trial group and control group, 30 cases in each group. The control group was given oral use of Stanozolol and Cyclosporin A, and the trial group was orally given the recipe with the actions of tonifying kidney,activating bone-marrow,and unblocking collaterals,which is mainly composed of Radix Rehmanniae,Radix Rehmanniae Preparata,Caulis Spatholobi,Semen Cuscutae,Fructus Lycii,Radix Angelicae Sinensis, Fructus Ligustri Lucidi, Herba Ecliptae, Pheretima, and Semen Strychni Preparata. The clinical efficacy was evaluated after treatment,and peripheral hemogram and thromboelastogram Ma value of the two groups were compared before and after treatment. Results (1)The trial group had better western medicine therapeutic effect and traditional Chinese medicine (TCM)syndrome therapeutic effect than the control group, the difference being signficant (P < 0.01).(2) After treatment, TCM syndrome scores, parameters of blood routine test,thromboelastogram Ma value of the two groups were improved compared with those before treatment (P < 0.05 or P < 0.01),and the improvement in the trial group was superior to that in the control group (P <0.05). Conclusion Therapy of tonifying kidney, activating bone-marrow, and unblocking collaterals is effective on improving blood coagulation function by increasing the quality and amount of platelet.

Role of heteroplasmic mutations in the mitochondrial genome and the ID4 gene promoter methylation region in the pathogenesis of chronic aplastic anemia in patients suffering from Kidney yin deficiency / 中国结合医学杂志

<p><b>OBJECTIVE</b>To analyze changes in gene amplification in the mitochondrial genome and in the ID4 gene promoter methylation region in patients with chronic aplastic anemia (CAA) suffering from Kidney (Shen) yin deficiency or Kidney yang deficiency.</p><p><b>METHODS</b>Bone marrow and oral epithelium samples were collected from CAA patients with Kidney yin deficiency or Kidney yang deficiency (20 cases). Bone marrow samples were collected from 20 healthy volunteers. The mitochondrial genome was amplified by polymerase chain reaction (PCR), and PCR products were used for sequencing and analysis.</p><p><b>RESULTS</b>Higher mutational rates were observed in the ND1-2, ND4-6, and CYTB genes in CAA patients suffering from Kidney yin deficiency. Moreover, the ID4 gene was unmethylated in bone marrow samples from healthy individuals, but was methylated in some CAA patients suffering from Kidney yin deficiency (positive rate, 60%) and Kidney yang deficiency (positive rate, 55%).</p><p><b>CONCLUSIONS</b>These data supported that gene mutations can alter the expression of respiratory chain enzyme complexes in CAA patients, resulting in energy metabolism impairment and promoting the physiological and pathological processes of hematopoietic failure. Functional impairment of the mitochondrial respiration chain induced by gene mutation may be an important reason for hematopoietic failure in patients with CAA. This change is closely related to maternal inheritance and Kidney yin deficiency. Finally, these data supported the assertion that it is easy to treat disease in patients suffering from yang deficiency and difficult to treat disease in patients suffering from yin deficiency.</p>

Clinical study of pai-neng-da capsule in the treatment of chronic aplastic anemia / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Pai-Neng-Da Capsule (panaxadiol saponins component, PND), a new Chinese patent medicine, on patients with chronic aplastic anemia (CAA) and to explore the optimal therapeutic regimen for CAA.</p><p><b>METHOD</b>A total of 36 patients with CAA were enrolled and divided into three groups: the AP group (20 cases, andriol 120 mg/day + PND 240 mg/day), the ACP group (13 cases, andriol 120 mg/day + cyclosporine 3-6 mg kd(-1) day(-1) + PND 240 mg/day), and the PND group (3 cases, PND 240 mg/day). All patients were treated and followed up for 6 months. Peripheral blood counts, renal and hepatic function and Chinese medical (CM) symptoms of patients were assessed and all indices were gathered at the beginning and end of the study.</p><p><b>RESULT</b>In the AP group, no significant hematologic difference was observed at the end of 6-month treatment comparing with the beginning. In the ACP group, the blood counts were maintained at the same level after the 6-month treatment. In the PND group, trilineage hematologic improvement was displayed at the end of 6-month treatment comparing with the beginning. No significant difference was showed in renal and hepatic function in all patients. All patients' clinical symptom improved according to CM symptom score. The effective rates were 95%, 73% and 100%, respectively.</p><p><b>CONCLUSION</b>PND improved the efficacy and decreased side effects by cutting down the dosage of andriol, and it could also improve patients' clinical symptom and quality of life. PND were effective and safe in the treatment of CAA, it could be used alone or in combination with pharmacological agents such as andriol and cyclosporine.</p>

Impact of Modified Bazhen Decoction on Bone Marrow Fibroblast Growth Factor-1 in Chronic Aplastic Anemia Patients / 广州中医药大学学报

Objective To observe the effect of modified Bazhen Decoction ( MBD) on bone marrow fibroblast growth factor-1 ( FGF-1) in chronic aplastic anemia ( CAA) patients. Methods Sixty cases of CAA were randomly divided into treatment group and control group, 30 cases in each group. Both groups were given conventional western medicine such as oral use of Stanozolol and Ciclosporin, and additionally, the treatment group received oral use of MBD. Six months constituted one treatment course for both groups. After treatment, the clinical efficiency in western medicine field and on Chinese medical syndromes was evaluated in both groups. The changes of peripheral hemogram, adverse reaction, and FGF-1 in the bone marrow of both groups were also monitored. Results ( 1) Clinical efficacy in western medicine field was 80.0% in the treatment group, and was 66.7%in the control group (P<0.05). (2) The total effective rate on Chinese medical syndromes was 100.0% in the treatment group, and was 83.3%in the control group (P<0.05). (3) After treatment, the scores of symptoms were decreased in both groups (P<0.05 or P<0.01 compared with those before treatment), and the decrease in the treatment group was superior to that in the control group (P<0.05). (4) Peripheral white blood cell (WBC) count, hemoglobin (HGB) content and platelet (PLT) count as well as bone marrow FGF-1 were increased in both groups after treatment (P<0.01 compared with those before treatment), and the increase of WBC, HGB, PLT and FGF-1 in the treatment group was superior to that in the control group (P<0.05). (5) In the aspect of the adverse reaction, the treatment group had 2 cases of hepatic fucntion injury, and one case of acne and hairiness; the control group had 2 cases of gum hypertrophy, 5 cases of hepatic function injury, and 4 cases of acne and hairiness. The control group had higher incidence of adverse reaction ( P<0.05). Conclusion MBD exerts certain therapeutic effect for CAA, and one of the possible mechanisms is related with the regulation of FGF-1 level.

Treatment of Chronic Aplastic Anemia based on the kidney / 国际中医中药杂志

This text is based on the analysis of the arteries that reported in the literatures over the past 10 years and combines with the chinese medicine practice of theory and clinical. It researches the etiology and pathogenesis of chronic aplastic anemia and the chinese medicine therapy from the kidney, and comes up with the treatment countermeasure of nourishing the kidney and marrow and invigorating the blood, then we formulate a proprietary named Bushenyisui Huoxuefang.

Effect of Chronic Aplastic Anemia Treated with Promoting Kidney and Tonifing Bone Method on the Expression of Hematopoiesis Regulation Factors IL-3,SCF,IFN-? and TNF-? mRNA / 中国中医药信息杂志

Objective To observe the effect of chronic aplastic anemia patients treated with promoting kidney and tonifing bone herbs on the expression of hematopoiesis regulation factors,and discuss the mechanism of kidney-promoting herbs. Methods 120 cases of chronic aplastic anemia were randomly divided into two groups,90 cases treated with promote kidney and tonify bone method,and 30 cases treated with western medicine. Besides these,10 cases of volunteers’ bone marrow were collected as normal control. Hematopoiesis regulation factors such as SCF,IL-3,TNF-? and IFN-? mRNA semi-quantitative expression were observed by RT-PCR. Results The expression level of SCF and IL-3 mRNA in two groups was lower obviously than normal control(P

Effect of Bushen Granule on the Expressions of CD28 and CD95 in Chronic Aplastic Anemia Patients / 中医杂志

Objective To study the mechanism of Bushen Granule (G ranule for rein forcing the kidney) for the treatment of chronic aplastic anemia (CAA). Methods The CAA patients were divided into the herbal group (60 cases) treated mainly by Bu shen Granule with syndrome differentiation and the Cyclosporin A group (16 cases ) tr eated mainly by Cyclosporin A for 6 months. The healthy control group consisting of 20 healthy subjects was set up. The expressions of CD3 +, CD3+CD28+, and CD3+CD95+ of the healthy control groups were compared with the herbal group and the Cyclosporin A group. Results The expressions of CD3 +, CD3+CD28+, and CD3+CD9 5+ of the CAA groups were higher than those of the healthy control group (P

Clinical analysis of ineffective red blood cell transfusions in patients with chronic aplastic anemia / 中国输血杂志

Objective To study the clinical effectives of red blood cell transfusion in patients with chronic aplastic anemia (CAA). Methods 425 CAA patients, from January 1995 to August 2007, were reviewed, and the rate of ineffective transfusions and its relationship to patients' age, sex, level of Hb before transfusion, times and volume of previous transfusions were analyzed.Results Of the 425 patients, ineffective transfusions occurred in 39 patients (9.2%). Of the 1 416 units of red blood cells transfused, 249 units (17.6%) were ineffective. The ineffective transfusions were not related to patients' age, sex or levels of Hb before transfusion, but were related to the times and volume of previous transfusions.Condusion In CAA patients, the more the times and the larger the volume of previous transfusions, the higher the rate of ineffective transfusion would occur.