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Objective: To explore the relationship between CD8+ T-cell CD28 molecular expression in peripheral blood and TCM type in patients with chronic aplastic anemia (CAA)., Methods: Using flow cytometry to detect the CD28 expression in 45 in-patients or out-patients and 24 healthy subjects for control. And the relation with TCM type was analyzed from the immunological aspect., Results: (1) The levels of CD8, CD28, CD8+ CD28+ expression and CD8+ CD28+/CD8+ CD28- were all higher in the CAA patients than those in the healthy subjects (P < 0.05 or P < 0.01). (2) The levels of CD28, CD8+ CD28+ expression and CD8+ CD28+/CD8+ CD28- were all higher in the CAA patients of Shen-Yin deficiency type than those in the CAA patients of Shen-Yang deficiency type (P < 0.05 or P < 0.01)., Conclusion: (1) The abnormal high expression of peripheral blood co-stimulatory molecules CD28 suggested CD28 disorder may play an important role in immuno-pathogenesis of CAA. (2) The levels of peripheral CD28, CD8+ CD28+ expression and CD8+ CD28+/CD8+ CD28- can be taken as an objective indexes for TCM typing of CAA, which was disordered more severe in patients of Shen-Yin deficiency type than in those of Shen-Yang deficiency type.

Hemopoietic progenitor cells (BFU-E, CFU-E and CFU-GM) of 69 cases of aplastic anemia were cultured in vitro while the sensitivity of CFU-E and BFU-E to androgen was assayed. The suppressive effect of peripheral blood mononuclear cell (PBMNC) from patients on normal CFU-GM growth was also studied. Hence 69 cases of aplastic anemia were divided into three types: 10 cases of stem cell deficiency type, 30 cases of immuno-mediated type and 29 cases of androgen response type. According to above classification, different treatment programs were practiced using both TCM and western medicine. In the androgen response type, androgen and TCM were used and the effective rate reached 92.3%. In the immuno-mediated type, in addition to TCM. Immunosuppressive agents were cautiously used and the effective rate was 70.6%. As for the stem cell deficiency type, 10 patients' conditions were usually very severe so comprehensive therapeutical means were adopted and 3 cases were improved. The overall response rate of these three was 73.2%. These results showed that the treatment program under the direction of classification have greatly improved the curative effect.

Aplastic anemia can be classified distinctively three types as progenitor depletive; immunosuppressive and androgenic sensitive. Using bone marrow culture in vitro which had been accomplished in our laboratory, 53 patients with aplastic anemia were also classified according to TCM term in three groups as Yin deficiency, Yang deficiency and both Yin and Yang deficiency, and the correlation was observed between TCM classification and lab character of these patients. The results showed that the number of CFU-GM, CFU-E and BFU-E in Yang deficiency group was significantly higher than that in the other two groups (P less than 0.01 and P less than 0.05). It also showed that the sensitivity of progenitor cells to androgenic hormones of Yang deficiency group was preferential to all (P less than 0.005 and P less than 0.05). The percentage of immunosuppressive type of aplastic anemia in Yin deficiency group was much higher than those in the other two groups (P less than 0.005). These observations suggested that TCM classification for aplastic anemia in this paper has objective material foundation.

The T-lymphocyte subsets of 38 patients with chronic aplastic anemia (CAA) were measured by monoclonal antibody (McAb) and ABC method and the relationship of T-lymphocyte subsets and symptom complex groups by traditional Chinese medicine theory were also analysed. It was shown that the T subsets of patients with CAA have remarkable changes: Ts (41.3 +/- 11.2%) increased more than the control (22.9 +/- 4.5%), Th/Ts decreased significantly more than the normal control (0.98 +/- 0.38 to 1.59 +/- 0.38). From the group of deficiency of both vital energy and blood to the group of deficiency of Kidney-yang to the group of deficiency of Kidney-Yin to the group of deficiency of both Kidney-Yang and Kidney-Yin, the Th lymphocyte gradually decreased, Ts lymphocyte successfully increased (from 33.8 +/- 7.9% to 57.7 +/- 7.5%), Th/Ts ratio declined (from 1.29 +/- 0.36 to 0.57 +/- 0.19). The Th/Ts ratio of the latter two groups decreased more than the former two groups (P less than 0.01). These results indicated that the T lymphocyte subsets and symptom complex group of patients with CAA were closely related and when deficient Yang affects Yin the immunologic function of body has a more obvious change. This revealed the connotation of Kidney-Yin and Kidney-Yang on the immuno-regulating cells (T lymphocyte subsets) level.