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Journal of Traditional Chinese Medicine ›› 2024, Vol. 44 ›› Issue (3): 537-544.DOI: 10.19852/j.cnki.jtcm.20240423.003

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Hemostatic mechanism of Jianpi Yiqi Shexue decoction (健脾益气摄血方) in treatment of immune thrombocytopenia

LI Ruibai1, CHEN Ke2(), MA Wei3, ZHANG Yayue3, HOU Li3, CHEN Xinyi3()   

  1. 1 Department of Oncology and Hemotology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China and Department of Hemotology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
    2 Department of Hemotology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
    3 Department of Oncology and Hemotology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
  • Received:2023-01-11 Accepted:2023-04-27 Online:2024-06-15 Published:2024-04-30
  • Contact: CHEN Ke,CHEN Xinyi
  • About author:CHEN Ke, Department of Hemotology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China. 18810482625@163.comTelephone: +86-10-84017637; +86-10-62835362
    CHEN Xinyi, Department of Hemotology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China. chenxinyi0729@126.com;
  • Supported by:
    National Key Basic Research and Development Program (973 Program) Project: the Therapeutic Mechanism and Pattern of Spleen Based Treatment for Thrombocytopenic Purpura Caused by Spleen Failure to Regulate Blood Flow(2013CB531705)

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Abstract:

OBJECTIVE: To explore the early hemostatic mechanism of Jianpi Yiqi Shexue decoction (健脾益气摄血方, JYSD) in treating immune thrombocytopathy (ITP), based on the functional homeostasis of brain-intestine axis and blood neurotransmitter

METHODS: Non-drug treatment cases: Healthy volunteers were selected as normal control group and compared with patients with dysfunctional uterine bleeding, gastrointestinal tumors with bleeding and ITP, to detect the changes of blood 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), vasoactive intestinal peptide (VIP) and compare the changes of blood neuro-transmitters in patients with different disease symptoms. Drug treatment cases: According to the randomized controlled multicenter clinical trial, 272 ITP patients were randomly divided into three groups: treatment group (JYSD) combined group (JYSD + Prednisone) control group (Prednisone). The changes of blood neuro-transmitter (5-HT, β-EP, VIP) before and after treatment were detected on the basis of peripheral blood platelet (PLT) and grade score.

RESULTS: Non-drug treatment cases: compared with the normal control group, the 5-HT level was higher, and the VIP and β-EP levels were both lower in the ITP group (P < 0.001), and the 5-HT, VIP and β-EP levels in the Gastrointestinal tumors with bleeding group were also lower compared with the normal control group (P < 0.05, 0.001). Drug treatment cases: The PLT grading scores of the combination group and the control group after treatment were lower than that before treatment (P < 0.05, 0.001). The PLT grading score of the 3 groups were compared in pairs after treatment: the combination group was the lowest among the 3 groups, which was better than the treatment group, but no better than the control group (vs the treatment group, P = 0.005, vs the control group, P = 0.709). The statistical results of full analysis set (FAS) and per protocol set (PPS) were consistent. The bleeding symptom scores of the treatment and combination groups began to drop 7 d after treatment, and kept dropping 14 d after treatment until the end of the study (P < 0.05). On the other hand, the control group started to show favorable results 14 d after treatment (P < 0.05). The FAS and PPS analysis results were consistent. In the control group, the 5-HT level was higher and VIP level was lower after treatment, compared with those before treatment (P < 0.05, 0.001). The β-EP levels were both increased in the treatment and combination group after treatment, compared with those before treatment (P < 0.05). After treatment, the β-EP levels in the treatment and control groups were significantly lower compared with the combination groups (P < 0.05). After treatment, compared with the control group, the VIP levels in the treatment and combination groups were up-regulated, and the differences were statistically significant by rank sum test (P < 0.01), and by t-test (P = 0.0002, 0.0001).

CONCLUSIONS: The prednisone tablet is better than the JYSD in increasing the level of PLT, while prednisone tablet combined with JYSD has more advantages in improving patients’ peripheral blood PLT levels. However, in improving the bleeding time of ITP patients, the combination of the two drugs was significantly delayed compared with the single usage, showing the characteristics and advantages of traditional Chinese medicine. JYSD can regulate the neurotransmitter level of ITP patients through the function of the brain-gut axis, mobilize 5-HT in the blood of ITP patients to promote the contraction of blood vessels and smooth muscles, and activate the coagulation mechanism are the early hemostatic mechanisms of JYSD. Up-regulate the levels of β-EP and balancing VIP levels may be an important part of the immune mechanism of JYSD for regulating ITP patients.

Key words: immune thrombocytopenic purpura, brain-gut axis, vasoactive intestinal peptide, beta-endorphin, serotonin

Cite this article

LI Ruibai, CHEN Ke, MA Wei, ZHANG Yayue, HOU Li, CHEN Xinyi. Hemostatic mechanism of Jianpi Yiqi Shexue decoction (健脾益气摄血方) in treatment of immune thrombocytopenia[J]. Journal of Traditional Chinese Medicine, 2024, 44(3): 537-544.