世界中医药

目的:探讨八珍汤对急性白血病化疗后骨髓抑制疗效,对其作用机制进行探讨,以期精准治疗。方法:选取2016年5月至2018年12月日照市中医院收治的急性白血病化疗后骨髓抑制患者76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38例。对照组常规西医治疗,观察组加用八珍汤治疗,均同时治疗4周。观察2组患者治疗前、完成治疗后血常规、Notch信号通路相关蛋白、生命质量、免疫功能变化并比较,比较2组患者不良反应和骨髓抑制程度情况。结果:1)完成治疗后2组患者白细胞(WBC)、血红蛋白(HGB)、血小板(PLT)、粒细胞较治疗前均显著升高(P<005),完成治疗后观察组以上指标均显著高于对照组(P<005)。2)完成治疗后2组患者jagl、notch2较治疗前均显著下降,观察组完成治疗后numb1、nubm2较治疗前均显著升高(P<005),对照组完成治疗后较治疗前numb1、nubm2比较，差异无统计学意义(P>005),完成治疗后观察组jagl、notch2显著低于对照组,numb1、nubm2显著高于对照组(P<005)。3)完成治疗后2组患者疲劳、疼痛、恶心、呕吐积分较治疗前均显著下降,躯体、角色、认知、情绪、社会功能积分较治疗前显著升高(P<005),完成治疗后观察组疲劳、疼痛、恶心、呕吐显著低于对照组,余均显著高于对照组(P<005)。4)完成治疗后观察组感染、电解质紊乱、肝肾功能异常、黏膜损伤、恶心呕吐发生率均显著低于对照组,比较差异有统计学意义(P<005)。5)完成治疗后观察组CD4+、CD4+/CD8+、IgE、IgA、IgM、NK细胞较治疗前均显著升高,CD8+显著下降(P<005),而对照组治疗前、完成治疗后比较，差异则不显著(P>005),完成治疗后观察组CD8+显著低于对照组,余均显著高于对照组(P<005)。6)完成治疗后观察组骨髓抑制程度0级显著高于对照组,Ⅲ级显著低于对照组,比较差异有统计学意义(P<005)。结论:八珍汤能通过提高急性白血病化疗后骨髓抑制免疫功能和血常规,从而改善生命质量,提高疗效,且不良反应发生率低。

English Summary:

To explore the effect of Bazhen Decoction on bone marrow suppression in acute leukemia patients after chemotherapy，and to explore its mechanism of action in order to achieve precise treatment.Methods:A total of 76 patients with bone marrow suppression after chemotherapy for acute leukemia were enrolled in our hospital from May 2016 to December 2018.They were randomly divided into control group(38 cases)and research group(38 cases).The control group was treated with routine western medicine and the study group was treated with Bazhen Decoction for 4 weeks at the same time.The changes of blood routine，Notch signaling pathway related proteins，quality of life and immune function before and after treatment were observed and compared between the two groups.The adverse reactions and the degree of bone marrow suppression were compared between the two groups.Results:After treatment，WBC，HGB，PLT and granulocyte in the two groups were significantly higher than those before treatment(P<005)，and the above indexes in the study group were significantly higher than those in the control group(P<005). 2)After treatment，jagl and Notch2 in both groups decreased significantly，numb1 and nubm2 in the study group increased significantly after treatment(P<005).There was no significant difference in numb1 and nubm2 in the control group(P>005).After treatment，jagl and Notch2 in the study group were significantly lower than those in the control group，and numb1 and nubm2 in the study group were significantly higher than those in the control group(P<005) 3)After treatment，the scores of fatigue，pain，nausea and vomiting in the two groups were significantly lower than those before treatment，and the scores of body，role，cognition，emotion and social function were significantly higher than those before treatment(P<005).After treatment，the scores of fatigue，pain，nausea and vomiting in the study group were significantly lower than those in the control group，and the others were significantly higher than those in the control group(P<005). 4)The incidence of infection，electrolyte disturbance，abnormal liver and kidney function，mucosal injury and nausea and vomiting in the study group were significantly lower than those in the control group after treatment，and the difference was statistically significant(P<005). 5)After treatment,CD4+,CD4+/CD8+，IgE，IgA，IgM and NK cells in the study group were significantly higher than those before treatment，and CD8+ was significantly lower than those before treatment(P<005)，but there was no significant difference between the control group before treatment and after treatment(P>005).After treatment，CD8+ in the study group was significantly lower than that in the control group，and the rest were significantly higher than those in the control group(P<005)._After treatment，the bone marrow depression level 0 in the study group was significantly higher than that in the control group，and grade III was significantly lower than that in the control group，with significant difference(P<005).Conclusion:Bazhen Decoction can improve the quality of life and curative effect by improving bone marrow suppression immune function and Hemogram of acute leukemia patients after chemotherapy，and the incidence of adverse reactions is low.

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