青黄散及健脾补肾方药联合西药治疗骨髓增生异常综合征107例临床观察

DOI:10．13288/j．11-2166/r．2014．10．009临床研究*[e-mail]01062874101107周庆兵，王洪志，杨秀鹏，郭小青，杨晓红，许勇钢，胡晓梅，麻柔*11000913097381230973903观察青黄散加补肾健脾中药联合西药治疗骨髓增生异常综合征(MDS)的临床疗效。收集107例MDS患者，给予青黄散、健脾补肾汤药及雄性激素，治疗时间为3个月，检测治疗前后患者外周血白细胞(WBC)计数、血红蛋白(Hb)含量、血小板(PLT)计数，并评价血液学指标疗效、不同分型疗效、不同国际预后积分系统(IPSS)危险度分层疗效、不同遗传学分组疗效。107例患者治疗前后外周血细胞计数比较，WBC、PLT治疗前后差异无统计学意义(P＞0.05)，Hb含量治疗前后差异有统计学意义(P＜0.01)。Hb与WBC疗效比较、Hb与PLT疗效比较差异均有统计学意义(P＜0.01)，而WBC与PLT疗效比较差异无统计学意义(P＞0.05)。两组患者不同分型疗效比较、不同IPSS危险度分层疗效比较、不同遗传学分组疗效比较差异均无统计学意义(P＞0.05)。青黄散加健脾补肾中药联合西药综合治疗MDS具有确切的临床疗效，主要对红系起作用，疗效与分型、IPSS危险度分层及遗传学分组无明显相关性。骨髓增生异常综合征;青黄散;健脾补肾;中西结合治疗myelodysplasticsyn-dromesMDS/、。1－2MDS。11.1诊断标准《》3。《》4。1.2纳入标准18～801。1.3排除标准、、、。1.4一般资料1072009820121052553～7639.8±17.873/ＲA/ＲAS14ＲC-MD751ＲAEB-1132ＲAEB-25。11066838+817615。IPSS38Ⅰ86Ⅱ84。22.1治疗方法2.1.1西药治疗·838·201455510JournalofTraditionalChineseMedicine2014Vol．55No．102mgH450207282mgCatalentFranceBein-heimS.A.40mgBH2005009440mg350mgH12020230100mg3。3。Hb50g/L38.5℃。2.1.2中药治疗0.4g0.24g、0.16g0.4g1。15g15g10g10g10g10g15g15g30g20g30g10g10g40g10g、10g。12。3。2.2观察指标及方法2.2.1白细胞(WBC)计数、Hb含量及血小板(PLT)计数NihonKohden、。2.2.2不同分型疗效107ＲA/ＲAS、ＲCMD、ＲAEB-1、ＲAEB-2。2.2.3不同IPSS危险度分层疗效106、Ⅰ、Ⅱ。2.2.4不同遗传学分组疗效106、+8、、。2.3疗效判定标准56。①＜5%Hb≥110g/LPLT≥100×109/L≥1.0×109/L0。②Hb≥15g/L884PLT＞20×109/LPLT≥30×109/L＜20×109/L＞20×109/L100%＜1.0×109/L＞100%＞0.5×109/L。③8。④＜5%≥50%＞5%5%～10%≥50%＞10%10%～20%≥50%＞20%20%～30%≥50%＞30%PLT≥50%、Hb≥20g/L。2.4统计学方法SPSS17.0t。33.1107例患者治疗前后外周血细胞比较1107WBC、PLTP＞0.05HbP＜0.01。1107MDS珋x±sWBC×109/LHbg/LPLT×109/L1073.35±1.9082.56±24.2773.84±87.891073.62±1.8991.22±27.97*83.54±100.04*P＜0.013.2血液学指标疗效比较2P＜0.01HbWBC、HbPLTP＜0.01WBCPLTP＞0.05。2107MDSWBC10711924Hb10737673PLT107119243.3不同分型疗效比较3P＞0.05。3107MDSＲA/ＲAS141382ＲCMD75334344ＲAEB-11303100ＲAEB-2510403.4不同IPSS危险度分层疗效比较4IPSSP＞0.05。·938·201455510JournalofTraditionalChineseMedicine2014Vol．55No．104106MDSIPSSIPSS80332Ⅰ86435416Ⅱ81241400403.5不同遗传学分型疗效比较5P＞0.05。5106MDS68330287+817241016015015041014MDS、“”。、“”“”。、、、、。HbWBCPLTHbWBCPLTMDSMDSＲC-MD70.9%IPSSMDS。MDS。1063835.8%。MDS、IPSS。1.J.2008283216-218.2.36J.2011523241-242.3.J.20024112846-848.4.J.200929111040-1041.5TefferiABarosiGMesaＲAetal.InternationalWork-ingGroupIWGconsensuscriteriafortreatmentresponseinmyelofibrosiswithmyeloidmetaplasiaOnbehalfoftheIWGformyelofibrosisresearchandtreatmentIWG-MＲTJ.Blood200610851497-1503.6ChesonBDBennettJMKantarjianHetal.ＲeportofaninternationalworkinggrouptostandardizeresponsecriteriaformyelodysplasticsyndromesJ.Blood200096123671-3674.ClinicalObservationonQinghuangPowderSpleen-StrengtheningKidney-SupplementingFormulasandWest-ernMedicinefor107CasesofMyelodysplasticSyndromeZHOUQingbingWANGHongzhiYANGXiupengGUOXiaoqingYANGXiaohongXUYonggangHUXiaomeiMAＲouXiyuanHospitalChinaAcademyofChineseMedicalSciencesBeijing100091ABSTＲACTObjectiveToobservetheefficacyofQinghuangPowderSpleen-StrengtheningKidney-Supplemen-·048·201455510JournalofTraditionalChineseMedicine2014Vol．55No．10tingFormulaSKFandwesternmedicineformyelodysplasticsyndromeMDS．MethodsTotally107casesofoutpatientwithMDSwereincludedandtreatedwithQinghuangPowderSKFandandrogens．Thetreatmentlastedfor3months．ThewhitebloodcellWBCcounthemoglobinHblevelandplateletPLTcountweredetectedbeforeandaftertreatment．TheefficacyofbloodcellstypesInternationalPrognosticScoringSystemIPSSandge-neticgroupswereevaluated．ＲesultsTherewasnosignificantdifferencebetweenbeforeandaftertreatmentinWBCandPLTP＞0.05．TherewasasignificantdifferencebetweenbeforeandaftertreatmentinHbP＜0.05．TherewasasignificantdifferencebetweentheefficacyofHbandWBCP＜0.01．TherewasasignificantdifferencebetweentheefficacyofHbandPLTP＜0.01．TherewasnosignificantdifferencebetweentheefficacyofWBCandPLTP＞0.05．TherewasnosignificantdifferenceintheefficacyoftypesIPSSandgeneticgroupsP＞0.05．ConclusionThecombotherapyofQinghuangPowderSKFandwesternmedicineiseffectiveforMDSandmainlyaffectserythroidcells．TheefficacyisnotobviouslycorrelatedwithtypesIPSSandgeneticgroups．KeywordsmyelodysplasticsyndromeQinghuangPowderstrengthenthespleenandsupplementthekidneyinte-grativemedicineclinicalefficacy2013－12－142014－01－15［编辑:叶晨］、、。、。“”、。、、《》“”。。、1.、、、2.、、。、1.、、2.、、3.。、[e-mail]。、2015331。、《》、《》、《》《》。、120000310000880001550001000。SCI。“·”《》、《》“·””。。1.、、、、、、。2.、、、、、、。8001、、、4、、。、、、。20141130。。[e-mail]·148·201455510JournalofTraditionalChineseMedicine2014Vol．55No．10