世界中医药

目的：观察升麻鳖甲汤辅助治疗急性髓性白血病的临床疗效，并评估其对患者T淋巴细胞亚群的影响。方法：选取2012年4月至2015年4月兖矿集团有限公司总医院收治的急性髓性白血病患者70例作为研究对象，按照随机数字表法分为对照组和观察组，每组35例。将同期健康体检的志愿者35例作为健康对照组。2组患者均接受常规治疗，包括保肝、止吐、营养支持等。对照组在常规治疗基础上予DA、HA或是EA方案诱导治疗，观察组在对照组方案基础上加用升麻鳖甲汤，每日1剂，200 mL煎服，早晚分服温服，连续服用60剂。观察治疗前后2组患者SF-36生命质量量表、造血恢复时间、复发时间及并发症发生情况、白细胞介素-2（IL-2）、白细胞介素-4（IL-4）、白细胞介素-10（IL-10）以及干扰素（IFN-γ）水平以及CD3+、CD4+、CD8+水平的变化。结果：2组患者治疗后SF-36生命质量量表评分均较治疗前增加，差异有统计学意义（P<0.05），其中观察组增加幅度优于西药对照组，差异有统计学意义（P<0.05）；察组患者骨髓有核细胞(ANC)>0.5×109/L恢复时间、血小板>20.0×109/L恢复时间较对照组明显缩短，差异有统计学意义（P<0.05），复发时间较对照组明显延长，差异有统计学意义（P<0.05）。治疗后2组患者的CD3+、CD4+、CD4+/CD8+均较治疗前升高，CD8+较治疗前降低，其中观察组改善较对照组明显，差异有统计学意义（P<0.05），治疗后2组患者与健康对照组比较，差异有统计学意义（P<0.05）。治疗后2组患者的IL-2、IFN-γ均较治疗前升高，IL-4、IL-10均较治疗前下降，其中观察组改善较优于对照组，差异有统计学意义（P<0.05），治疗后2组患者与健康对照组比较，差异有统计学意义（P<0.05）。2组治疗过程中出现不良反应主要是咽部感染、尿血、口腔感染及胃肠道反应，观察组不良反应的发生率低于对照组，差异有统计学意义(P<0.05)。结论：升麻鳖甲汤可有效辅助治疗急性髓性白血病，降低不良反应的发生率，其作用机制可能与纠正患者T细胞亚群紊乱有关。

English Summary:

To observe the clinical efficacy of Shengma Biejia Decoction in the treatment of acute myeloid leukemia and evaluate its effect on T lymphocyte subsets in patients.Methods：A total of 70 cases of acute myeloid leukemia in Yankuang Group Co.，Ltd.General Hospital from April 2012 to April 2015 were included in the study.The random number method was used to divide into a control group and an observation group，with 35 cases in each group.35 healthy people in the same period were used as healthy control group.Two groups of patients received routine treatment，including liver protection，antiemetic，nutritional support，etc.The control group was treated with DA，HA or EA regimen on the basis of routine treatment.On the basis of the control group，the observation group added Shengma Biejia Decoction，1 dose per day，and 200 mL decoction，and took 60 doses with warm decoction in the morning and evening.The changes of SF-36 quality of life scale，hematopoiesis recovery time，recurrence time and complications，interleukin 2(IL-2)，interleukin 4(IL-4)，interleukin 10(IL-10)and interferon(IFN-gamma)concentration in the 2 groups were observed before and after treatment.The changes of CD3+，CD4+ and CD8+ levels were observed.Results：1)the score of SF-36 quality of life was increased after treatment in the 2 groups than before treatment(P<0.05)，and the increase of the observation group was better than that of the control group(P<0.05). 2)the recovery time of marrow nucleated cells(ANC)>0.5×109/L and recovery time of platelet>20.0×109/L in the observation group were obviously shortened than that of the control group(P<0.05)，and the recurrence time was significantly longer than that in the control group(P<0.05).3)After treatment，the CD3+，CD4+ and CD4+/CD8+ of the 2 groups were all higher than those before the treatment，and CD8+ was lower than that before the treatment.Among them，the observation group was better than that of the control group(P<0.05).The difference between the 2 groups after the treatment and the healthy control group was still statistically significant(P<0.05).4)after treatment，the IL-2 and IFN-gamma in the 2 groups were all higher than before the treatment，IL-4 and IL-10 were lower than those before the treatment，and the improvement of the observation group was better than that of the control group(P<0.05).The difference between the 2 groups after the treatment and the healthy control group was still statistically significant(P<0.05).5)The main adverse reactions in the 2 groups were pharynx infection，urine blood，oral infection and gastrointestinal reaction.The incidence of adverse reactions in the observation group was lower than that of the control group(P<0.05).Conclusion：Shengma Biejia Decoction can effectively assist in the treatment of acute myeloid leukemia and reduce the incidence of ADR，and its mechanism may be related to the correction of the disorder of T cell subgroup in patients.

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