Immune Thrombocytopenia and Treatment-associated Changes in Platelet-associated Antibodies and Cytokine/T-cell Profiles: A Retrospective Case-control Study with Modified Gui Pi Decoction
GuiPi Decoction and Modern Medicine
,
Abstract
To evaluate whether adjunctive Modified GuiPi Decoction provides additional benefit to standard immunosuppressive therapy in adult patients with chronic immune thrombocytopenia (ITP).
This retrospective cohort study included 120 adult patients aged 18–65 years, diagnosed with ITP according to the 2016 Chinese Expert Consensus. Patients received either standard therapy (cyclosporine A plus prednisone; comparison group, n = 60) or standard therapy plus Modified GuiPi Decoction (treatment group, n = 60) between July 2022 and July 2024.
After 12 weeks of treatment, the treatment group showed significantly greater improvement in fatigue severity score (mean reduction: 3.2 vs 1.8) and quality-of-life index (mean increase: 15.4 vs 9.1) compared to the comparison group. However, no significant between-group difference was observed in platelet count recovery (mean increase: 45.3 × 109/L vs 53.1 × 109/L), with the comparison group showing a numerically larger rise. Mild ALT/AST elevations were more pronounced in the treatment group.
In adult ITP patients, adjunctive Modified GuiPi Decoction may offer symptomatic and quality-of-life benefits beyond standard therapy, but did not demonstrate superior hematological response. Caution is warranted regarding potential hepatotoxicity.
1. Holt HD, Holt MF, Means RTJ. Concurrent pseudothrombocytopenia and immune thrombocytopenia. Am J Med Sci. 2022;364(3):e31-2.
2. Bonnard G, Babuty A, Collot R, Costes D, Drillaud N, Eveillard M, et al. Platelet features allow to differentiate immune thrombocytopenia from inherited thrombocytopenia. Ann Hematol. 2021;100(11):2677-82.
3. Al-Samkari H, Jiang D, Gernsheimer T, Liebman H, Lee S, Bernheisel C, et al. Durability of platelet response after switching to avatrombopag from eltrombopag or romiplostim in immune thrombocytopenia. Res Pract Thromb Hae. 2023;7(3):100134.
4. Donato H. Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion. Arch Argent Pediatr. 2021;119(4):e303-14.
5. Asatsuma Y, Mukai T, Ibi K, Kakiuchi S, Kato S, Takahashi N, et al. Child with refractory thrombocytopenia born to a mother with immune thrombocytopenia. Pediatr Int Official J Japan Ped Society. 2024;66(1):e15747.
6. Arvind MN, Rajanna AH, Kamath N. Acquired Amegakaryocytic Thrombocytopenia Misdiagnosed as Immune Thrombocytopenia in a Patient with Seronegative Arthritis: A Case Report. J Association Physicians India. 2023;71(11):100-2.
7. Huang C, Chen W, Wu Y, Shen C, Hsu C, Li C, et al. Comparison of antiplatelet antibody profiles between hepatitis C virus-associated immune thrombocytopenia and primary immune thrombocytopenia. Platelets. 2021;32(8):1043-50.
8. van Dijk WEM, Schutgens REG. Mycophenolate Mofetil for Immune Thrombocytopenia. New Eng J Med. 2021;385(23):2201.
9. Wu K, Yin H, Du A. Effects of Modified Jianpi Qushi Heluo Decoction on Scores of TCM Syndromes, 24 h Urinary Albumin, and Plasma Albumin in IMN of Spleen-Kidney Qi Deficiency. Emerg Med Int. 2022;2022:6061709.
10. Lu B, Ye Q, Pan Y, Lu J, Li L, Peng Y, et al. Tonifying spleen and replenishing kidney method of traditional Chinese medicine for myasthenia gravis: A protocol for systematic review and meta-analysis. Medicine. 2021;100(21):e25966.
11. Geng Y, Wang W, Zhang J, Bi S, Li H, Lin M. Effects of Traditional Chinese Medicine herbs for tonifying Qi and kidney, and replenishing spleen on intermittent asthma in children aged 2 to 5 years old. J Tradit Chin Med. 2016;36(1):32-8.
12. Bhamidipati K, Silberstein JL, Chaichian Y, Baker MC, Lanz TV, Zia A, et al. CD52 Is Elevated on B cells of SLE Patients and Regulates B Cell Function. Front Immunol. 2021;11:626820.
13. Olsson B, Ridell B, Carlsson L, Jacobsson S, Wadenvik H. Recruitment of T cells into bone marrow of ITP patients possibly due to elevated expression of VLA-4 and CX3CR1. Blood. 2008;112(4):1078-84.
14. Chen L, Ye T, Wang X, Han L, Wang T, Qi D, et al. The Mechanisms Underlying the Pharmacological Effects of GuiPi Decoction on Major Depressive Disorder based on Network Pharmacology and Molecular Docking. Comb Chem High T Scr. 2023;26(9):1701-28.
15. He X, Du X, Chen J. Study on the molecular mechanism of Guipi decoction against sleep deprivation based on integrated pharmacology analysis and gene expression profiling. Acta Neurobiol Exp. 2022;82(4):409-23.
16. Wang X, Bei H, Du R, Chen Q, Wu F, Chen J, et al. Metabolomic analysis of serum reveals the potential effective ingredients and pathways of Danggui Buxue Tang in promoting erythropoiesis. Complement Ther Med. 2020;48:102247.
17. Lee AR, Yang SW, Lee SY, Jeon SB, Kang HY, Choi JW, et al. Mitochondrial transplantation ameliorates experimental autoimmune encephalomyelitis by modulating the Th17/Treg balance and restoring metabolic homeostasis. Front Immunol. 2026;17:1698136.
18. Besancenot R, Roos-Weil D, Tonetti C, Abdelouahab H, Lacout C, Pasquier F, et al. JAK2 and MPL protein levels determine TPO-induced megakaryocyte proliferation vs differentiation. Blood. 2014;124(13):2104-15.
19. Xu Y, Lv W, Wu H, Shi SF. Ginsenoside regulates Treg/Th17 cell ratio and inhibits inflammation to treat COPD. Die Pharmazie. 2020;75(11):590-4.
20. Kim YK, Kim SE, Chang Park H, Hwang JH, Lee HT. Human recombinant IL-10 reduces xenogenic cytotoxicity via macrophage M2 polarization. Biochem Biophys Rep. 2020;24:100857.
21. He X, Du X, Chen J. Study on the molecular mechanism of Guipi decoction against sleep deprivation based on integrated pharmacology analysis and gene expression profiling. Acta Neurobiol Exp. 2022;82(4):409-23.
2. Bonnard G, Babuty A, Collot R, Costes D, Drillaud N, Eveillard M, et al. Platelet features allow to differentiate immune thrombocytopenia from inherited thrombocytopenia. Ann Hematol. 2021;100(11):2677-82.
3. Al-Samkari H, Jiang D, Gernsheimer T, Liebman H, Lee S, Bernheisel C, et al. Durability of platelet response after switching to avatrombopag from eltrombopag or romiplostim in immune thrombocytopenia. Res Pract Thromb Hae. 2023;7(3):100134.
4. Donato H. Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion. Arch Argent Pediatr. 2021;119(4):e303-14.
5. Asatsuma Y, Mukai T, Ibi K, Kakiuchi S, Kato S, Takahashi N, et al. Child with refractory thrombocytopenia born to a mother with immune thrombocytopenia. Pediatr Int Official J Japan Ped Society. 2024;66(1):e15747.
6. Arvind MN, Rajanna AH, Kamath N. Acquired Amegakaryocytic Thrombocytopenia Misdiagnosed as Immune Thrombocytopenia in a Patient with Seronegative Arthritis: A Case Report. J Association Physicians India. 2023;71(11):100-2.
7. Huang C, Chen W, Wu Y, Shen C, Hsu C, Li C, et al. Comparison of antiplatelet antibody profiles between hepatitis C virus-associated immune thrombocytopenia and primary immune thrombocytopenia. Platelets. 2021;32(8):1043-50.
8. van Dijk WEM, Schutgens REG. Mycophenolate Mofetil for Immune Thrombocytopenia. New Eng J Med. 2021;385(23):2201.
9. Wu K, Yin H, Du A. Effects of Modified Jianpi Qushi Heluo Decoction on Scores of TCM Syndromes, 24 h Urinary Albumin, and Plasma Albumin in IMN of Spleen-Kidney Qi Deficiency. Emerg Med Int. 2022;2022:6061709.
10. Lu B, Ye Q, Pan Y, Lu J, Li L, Peng Y, et al. Tonifying spleen and replenishing kidney method of traditional Chinese medicine for myasthenia gravis: A protocol for systematic review and meta-analysis. Medicine. 2021;100(21):e25966.
11. Geng Y, Wang W, Zhang J, Bi S, Li H, Lin M. Effects of Traditional Chinese Medicine herbs for tonifying Qi and kidney, and replenishing spleen on intermittent asthma in children aged 2 to 5 years old. J Tradit Chin Med. 2016;36(1):32-8.
12. Bhamidipati K, Silberstein JL, Chaichian Y, Baker MC, Lanz TV, Zia A, et al. CD52 Is Elevated on B cells of SLE Patients and Regulates B Cell Function. Front Immunol. 2021;11:626820.
13. Olsson B, Ridell B, Carlsson L, Jacobsson S, Wadenvik H. Recruitment of T cells into bone marrow of ITP patients possibly due to elevated expression of VLA-4 and CX3CR1. Blood. 2008;112(4):1078-84.
14. Chen L, Ye T, Wang X, Han L, Wang T, Qi D, et al. The Mechanisms Underlying the Pharmacological Effects of GuiPi Decoction on Major Depressive Disorder based on Network Pharmacology and Molecular Docking. Comb Chem High T Scr. 2023;26(9):1701-28.
15. He X, Du X, Chen J. Study on the molecular mechanism of Guipi decoction against sleep deprivation based on integrated pharmacology analysis and gene expression profiling. Acta Neurobiol Exp. 2022;82(4):409-23.
16. Wang X, Bei H, Du R, Chen Q, Wu F, Chen J, et al. Metabolomic analysis of serum reveals the potential effective ingredients and pathways of Danggui Buxue Tang in promoting erythropoiesis. Complement Ther Med. 2020;48:102247.
17. Lee AR, Yang SW, Lee SY, Jeon SB, Kang HY, Choi JW, et al. Mitochondrial transplantation ameliorates experimental autoimmune encephalomyelitis by modulating the Th17/Treg balance and restoring metabolic homeostasis. Front Immunol. 2026;17:1698136.
18. Besancenot R, Roos-Weil D, Tonetti C, Abdelouahab H, Lacout C, Pasquier F, et al. JAK2 and MPL protein levels determine TPO-induced megakaryocyte proliferation vs differentiation. Blood. 2014;124(13):2104-15.
19. Xu Y, Lv W, Wu H, Shi SF. Ginsenoside regulates Treg/Th17 cell ratio and inhibits inflammation to treat COPD. Die Pharmazie. 2020;75(11):590-4.
20. Kim YK, Kim SE, Chang Park H, Hwang JH, Lee HT. Human recombinant IL-10 reduces xenogenic cytotoxicity via macrophage M2 polarization. Biochem Biophys Rep. 2020;24:100857.
21. He X, Du X, Chen J. Study on the molecular mechanism of Guipi decoction against sleep deprivation based on integrated pharmacology analysis and gene expression profiling. Acta Neurobiol Exp. 2022;82(4):409-23.
| Files | ||
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Autoantibodies Chinese herbal C-reactive protein Cyclosporine Drugs Idiopathic Interleukin-6 Prednisone Purpura Thrombocytopenic T-lymphocyte subsets | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Yang Y, Yu S, Guo D, Meng F, Sun A, Sun W. Immune Thrombocytopenia and Treatment-associated Changes in Platelet-associated Antibodies and Cytokine/T-cell Profiles: A Retrospective Case-control Study with Modified Gui Pi Decoction. Iran J Allergy Asthma Immunol. 2026;:1-12.
