| 引用本文:赵攀1，2，邓中阳1，2，王明镜1，2，宋敏敏3，胡晓梅1.骨髓增生异常综合征的中医辨证论治[J].世界中医药,2017,(10):. |
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| 骨髓增生异常综合征的中医辨证论治 |
| Traditional Chinese Medicine Differential Treatment of Myelodysplastic Syndrome |
| 投稿时间：2016-10-26 |
| DOI：10.3969/j.issn.1673-7202.2017.10.017 |
| 中文关键词: 骨髓增生异常综合征 细胞遗传学 二代基因测序 雄黄 砷 辨证论治 |
| English Keywords:Myelodysplastic syndrome Cytogenetics Second generation gene sequencing Realgar Arsenic Syndrome differentiation and treatment |
| 基金项目:国家自然科学基金项目（81673821） |
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| 中文摘要: |
| 目的：探讨骨髓增生异常综合征（MDS）辨证论治的临床意义。方法：选取2014年6月至2016年6月中国中医科学院西苑医院血液科门诊MDS患者43例，辨证分为肝肾阴虚与脾肾阳虚2个证型，接受复方青黄散治疗2个疗程，分析2个证型患者在遗传学、危度分层、基因突变等精准指标下的客观化差异以及对复方青黄散的治疗反应。结果：1）2个证型患者临床特征：a.MDS亚型：脾肾阳虚组RAEB患者（5/31）显著高于肝肾阴虚组(0/12)（P<0.05）。b.遗传学：脾肾阳虚组预后好的核型（正常核型、+8、-Y）患者比例（22/31，）明显低于肝肾阴虚组（11/12）（P<0.05）。c.危度分层：脾肾阳虚组低危患者比例（4/31）明显低于肝肾阴虚组（3/12）（P<0.05）。d.基因测序：脾肾阳虚组合并突变者（11/14）较肝肾阴虚组（1/4）多见（P<0.05）。2）患者对复方青黄散的治疗反应：患者总有效率为90.69%。a.有效率：脾肾阳虚组（30/31）显著高于肝肾阴虚组（9/12）（P<0.05）。b.外周血细胞计数：脾肾阳虚组HB、NEUT显著升高（P<0.05）。输血量：48%患者摆脱输血（12/25）。2组患者人均月输血量显著下降（P<0.05）。结论：在遗传学、危度分层以及基因测序等层面上，脾肾阳虚型MDS较肝肾阴虚型更容易伴随预后较差的客观指标，但脾肾阳虚型患者对复方青黄散的治疗反应好于肝肾阴虚型。辨证分型有利于提供精准治疗方案。 |
| English Summary: |
| To explore the clinical significance of traditional Chinese medicine (TCM) differential treatment of myelodysplastic syndrome (MDS) in accurate age.Methods:A total of 43 patients with MDS from the outpatient in hematology department of Xiyuan Hospital, China Academy of Chinese Medical Sciences during 2014 to 2016 were selected and differentiated as liver-kidney yin deficiency syndrome and spleen-kidney yang deficiency syndrome.They were treated with Compound Qinghuang Powder (CQHP) for 2 courses, and the objective differences under accurate indicators of patients with two syndromes in chromosomal karyotypes, IPSS risk stratification and gene mutation, as well as the therapeutic response to the treatment with CQHP were analyzed.Results:1）The clinical characteristics of two syndrome types:a.MDS subtype:The number of RAEB patients in spleen-kidney yang deficiency group (5/31) was significantly larger than that in liver-kidney yin deficiency group (0/12)(P<0.05).b.Chromosomalkaryo types:The proportion of patients with sound karyotypes (normal karyotype,+8,-Y) in spleen-kidney yang deficiency group(22/31) was significantly lower than that in liver-kidney yin deficiency group (3/12) (P<0.05).c.IPSS risk stratification:The proportion of low-risk patients in spleen-kidney yang deficiency group (4/31) was significantly lower than that in liver-kidney yin deficiency group (3/12) (P<0.05).d.Gene sequencing:The number of patients with combined mutation in spleen-kidney yang deficiency group (11/14) was larger than that in liver-kidney yin deficiency group (1/4)(P<0.05).2）For the patients' responds to the treatment with CQHP, the overall effective rate was 90.69%.a.Efficient rate of spleen-kidney yang deficiency group (30/31) was significantly higher than that of liver-kidney yin deficiency group (9/12) (P<0.05).b.Peripheral blood count:HB and NEUT in spleen-kidney yang deficiency group were significantly increased (P<0.05).c.Blood transfusion:48% patients did not receive blood transfusion after treatment (12/25).Blood transfusion volume per capital in two groups was significantly decreased (P<0.05).Conclusion:From the perspective of chromosomal karyotypes, IPSS risk stratification and gene sequencing, patients with MDS of spleen-kidney yang deficiency syndrome is more likely to have objective indicators with poor prognosis, but have a better response to treatment of CQHP.TCM differential treatment is conducive to providing accurate treatment. |
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