消斑饮预防撤药综合征临床观察

Abstract

目的：探讨消斑饮对糖皮质激素(GCs)快速撤除的安全性。方法：用消斑饮治疗108例正在接受GCs治疗的免疫性血小板减少症(ITP)患者，用快速法撤除GCs。撤除前后在晨8~9点测定血浆ACTH和皮质醇(Cort)含量。仔细观察撤药后肾上腺危象(AC)，撤药症群的发生及ITP的反跳。并随访了37例患者的ACTH和Cort。结果：108例中在撤激素之前确诊有肾上腺机能不全(AI) (8 Am Cort < 30 µg/L)有62例，占57.4%，高度提示AI (8Am Cort 30~50 µg/L) 13例，占12.0%。经消斑饮治疗并撤除GCs一个月后，有撤药综合征66例，轻度者62例，中度4例，无一例发生AC。ITP反跳11例。结论：消斑饮是一种独立的，不需要配合GCs的ITP治疗方案。它之所以不需要GCs，是因为它有很强的保护肾上腺皮质功能作用，能很快恢复被外源性GCs抑制的肾上腺皮质功能。从而减轻了撤药症群的程度，预防了AC发生。 Objective: To explore the effects of Xiaoban Decoction to prevent the glucocorticoid (GC) with-drawal syndrome. Methods: Xiaoban Decoction was given to 108 immune thrombocytopenia (ITP) patients who have been treated with GCs. Glucocorticoid therapy was then stopped abruptly. Blood samples was taken around 8 am before and after the abruptly termination of glucocorticoid therapy. Adrenocorticotropic hormone (ACTH) and cortisol (Cort) levels were then determined. Clinical manifestations of adrenal crisis, withdrawal symptoms and relapse of ITP were carefully monitored. 37 cases were followed up for theirs ACTH and cortisol levels. Results: Among the 108 cases, 62 cases (57.4 percent) had adrenal insufficiency (AI) before stopping the glucocorticoid therapy (8 am cortisol level less than 30 µg/L). 13 (12 percent) cases had highly suggestive of AI (8 am cortisol level between 30 - 50 µg/L). After treatment with Xiaoban Decoction and termination of glucocorticoid, 66 cases had withdrawal syndrome. Among them, 62 cases were mild, 4 cases moderate and no patient withdrawal crisis. 11 had ITP relapse. Conclusions: Xiaoban Decoction is an independent Chinese medical treatment option for ITP. It doesn’t need to be used with glucocorticoid. It has strong effects in protecting the adrenal glands. Xiaoban Decoction can restore the adrenal gland’s function after it’s suppressed by external glucocorticoid. It can lessen the glucocorticoid withdrawal symptoms and prevent the occurrences of adrenal crisis.