Analysis Of TCM Syndromes Of Sjogren 's Syndrome Combined With Blood System Damage And Its Correlation With Immune Abnormality

Sjogren’s syndrome (SS) is a chronic inflammatory autoimmune disease, which mainly damages exocrine gland, especially salivary gland and lacrimal gland. The main clinical symptoms are dry mouth and dry eye, with a high degree of lymphocytic infiltration as its main feature. Systemic symptoms of fatigue and fever are often associated with SS, and it can affect multiple systems like blood system and thus leading to complicated clinical manifestations. In recent years, the blood system damage rate increased gradually, but the early symptoms of the disease are lack of specificity. Besides, the first symptoms are involved with multiple organs and systems. Therefore, patients often delayed their treatment due to the ignorance of symptoms or multidepartment misdiagnosis. Moreover, mild abnormal results of laboratory tests such as blood routine are often regarded as with no clinical significance, which increases the possibility of misdiagnosis and may delay the time of early treatment, cause more serious complications and even threaten the life of the patient.At present, there is no exact understanding about the pathogenesis of SS in modern medicine. The treatment is still dominated by alternative therapy to improve symptoms. Corticosteroids and immunosuppressive agents can be used to control or reverse the disease effectively when multiple organs and systems of the patients are injured by SS, but side effects are obvious and recurrence may happen,the patients have less compliance of medication. Traditional Chinese Medicine has obvious advantages in treatment of SS by Zhengti concept and Dialectical treatment theory to improve the symptoms of patients, reduce the side effects of Western medicine, reduce the recurrence rate and improve the life quality of the patients,it has wide prospect on treatment of SS.Objective:1 Using retrospective study method to explore the TCM basic syndrome characteristics of SS merged with blood system damage and provide an objective theory basis for clinical treatment of SS disease with TCM.2 To analysis the correlation between abnormal immunological indexes, blood system damage and blood cells reduction through the study of immune related examination and routine blood test.Looking for laboratory indexes with higher specificity to provide an objective basis for clinical diagnosis and treatment of SS.Methods:Study I:50 patients of Sjogren’s syndrome treated and diagnosed in department of hematology and immunology of Dongfang Hospital Affiliated to Beijing University of Chinese Medicine from 2009 December to 2014 June were chosen as the research object, and they were divided into the group with blood system damage and the group without blood system damage according to the results of blood tests. Descriptive statistical method of frequency distribution was used to investigate the TCM characteristics of SS by retrospective analysis and study the TCM characteristics of SS with blood system damage.Study II:To further understand the hematological abnormalities of SS through laboratory tests. And subdivided the group with blood system damage into leukopenia decrease group, hemoglobin decrease group and thrombocytopenia decrease group. To analysis the correlation between abnormal immunological indexes, blood system damage and blood cells reduction through the study of immunoglobulin, antinuclear antibody(ANA),anti SSB antibody, complement C3/C4 and rheumatoid factor.Using SPSS 20.0 to analyze the results. P<0.05 suggests that there was a significant difference. If the data were normally distribution, use paired samples T test; if not, use non parametric test of two related samples.Results:1 The basic information and TCM four diagnostic information of the 50 patients are as follows:Gender and age:mainly women in the age of 50-59.Duration:the longer the duration was, the more easily the blood system gets damaged.Symptoms:according to the frequency from high to low, the top ten symptoms are dry mouth, dry eyes, joint pain, fatigue, eating with water necessarily, poor sleep, cough and expectoration, backache, oral ulcers, sore muscles.Tongue:red tongue and crimson tongue occur as the top two highest frequency of tongue nature; less coat and thick white coat occur as the top two the highest frequency of coating on the tongue,the tongue with crack was more common than other body of tongue.Pulse condition:the most common pulse conditiongs was sink thin pulse,thin pulse.Syndromes:according to the frequency from high to low, syndromes are ranked as follows:Yin deficiency syndrome, qi deficiency syndrome, blood stasis syndrome, phlegm dampness syndrome, qi stagnation syndrome, Yang deficiency syndrome and blood deficiency syndrome. Therefore, we concluded that yin deficiency and qi deficiency were the main syndrome features of this disease, while other syndromes like blood stasis syndrome, phlegm damp syndrome et al may also be associated with it. Compared the group with blood system damage with the group without blood system damage, the difference of yin deficiency syndrome and qi deficiency syndrome distribution were not significant, while the difference of blood stasis syndrome characteristic was significant.2. The results of the analysis of primary Sjogren’s syndrome merged with blood system damage are as follows:2 27 cases of the 50 patients had blood system damage, so the incidence rate was 54%. The incidence rate of leukopenia is 38%, ranking as the first. The incidence rate of hemoglobin decrease is 22%, ranking as the second. The incidence rate of thrombocytopenia is 16%, ranking as the third. Among these three decreases, the incidence rate of only light leukopenia was 32%, ranking as the highest, and it also occurs in two-line reduction. Three-line reduction rarely occurs, but it was more serious. Merged with thrombocytopenia would increase the risk of bleeding. So this research warned that the incidence of blood system damage can’t be ignored.The effect of immune related examination on blood cells reduction: compared with the group without blood system damage, the group with blood system damage had significantly higher levels of IgG. Moreover, the results of complement C3and anti SSA antibody had significant difference (P<0.05).The comparison between leukocyte reduced group and the group without blood system damage indicated that complement C3 and anti SSA antibody had significant differences(P<0.05). The comparison between hemoglobin decrease group and the group without blood system damage indicated that complement C3 had significant differences (P<0.05).The comparison between thrombocytopenia group and the group without blood system damage indicated that complement C3/C4 had significant differences (P<0.05). The results showed that complement C3/C4 and anti SSA antibody were involved in the blood system damage and blood cells reduction caused by SS.Conclusion:1 The main TCM syndrome characteristics of Sjogren syndrome were deficiency of Qi and yin. The TCM syndrome characteristics of SS with blood system damage were deficiency of Qi and yin merged with blood stasis.2 Among these three-line decreases, the incidence rate of only light leukopenia was the highest, and two-line decreases also occur sometimes. Three-line decreases rarely occur, but more serious.3 The correlation of immune related examination abnormality with blood system damage showed:(1) The anti SSA antibody was involved with the damage of the blood system, especially in the damage of the white blood cells, but not obvious in the damage of hemoglobin and platelet.(2) Both complement C3 and complement C4 are involved in the blood cells decrease. Complement C3 affects all three-line blood system and complement C4 mainly affects platelet decrease.