真实世界中骨髓增生异常综合征患者的血常规与WHO分型、中医证型及治疗方案的关系  

Relationship between Blood Routine and WHO Classification,TCM Syndrome Type and Treatment Options of MDS Patients in the Real World

作　　者：高琰[1] 张盛琪 刘青果 张朝畅 唐旭东[2] GAO Yan;ZHANG Shengqi;LIU Qingguo;ZHANG Chaochang;TANG Xudong(Beijing University of Chinese Medicine,Beijing 100029,China;Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]北京中医药大学,北京100029 [2]中国中医科学院西苑医院,北京100091

出　　处：《辽宁中医药大学学报》2022年第11期87-92,共6页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81673819,82074258);中国中医科学院科技创新工程重大攻关项目(CI2021A01701)。

摘　　要：目的 探索真实世界中骨髓增生异常综合征(MDS)患者的血常规参数表现与WHO分型、中医证型及危险度分层(IPSS-R)的关系,归纳不同中医证型MDS患者的临床特征及MDS患者门诊治疗方案。方法 收集2018年10月—2021年10月于中国中医科学院西苑医院血液科门诊就诊的114例MDS患者的临床资料,对其血常规参数、临床特征及治疗方案进行分析。结果 (1)血常规表现:与MDS-RS患者相比,MDS-MLD患者的HGB与HCT水平较高;与高危组和极高危组的患者相比,极低危组和低危组的患者的WBC、ANC、M#、HGB、HCT较高。(2)不同中医证型患者的临床特征:气阴两虚型患者的ANC水平和ASXL1基因突变比例较脾肾两虚型患者高。(3)治疗方案:使用频次较多的中药依次为黄芪、当归、茯苓、白术、太子参、菟丝子、肉苁蓉、仙鹤草、枸杞子、生地黄;网络图显示黄芪、当归、茯苓、白术、太子参之间联系密切;雄激素为最常见的合并治疗方案[95例(83.3%)],其次为含砷中成药[78例(68.4%)]。结论 (1)HGB和HCT联合评价,对于MDS-RS和MDS-MLD的区分有一定临床提示意义;WBC、ANC、#M、HGB、HCT可以帮助判断IPSS-R不同预后特征的MDS患者群体。(2)ANC对于区分中医证型中的脾肾两虚和气阴两虚型有一定临床提示意义,气阴两虚型患者并不一定代表更好的预后。(3)MDS患者中药处方以补肾健脾、益气补血的药物为主,含砷中成药使用比例近70%,最常见的合并治疗为雄激素治疗,“补肾健脾中药+青黄散+雄激素”组合治疗临床疗效较好,值得推广。Objective To explore the relationship between the blood routine of patients with myelodysplastic syndrome(MDS)and WHO classification,TCM syndrome type and risk stratification(IPSS-R)in the real world,and to summarize the clinical characteristics of MDS patients with different TCM syndrome type and the outpatient treatment plan of MDS patients in traditional Chinese medicine hospital. Methods The clinical data of 114 MDS patients treated in the hematology department of Xiyuan hospital,China Academy of Chinese Medical Sciences from October 2018 to October 2021 were collected,and their blood routine parameters,clinical characteristics and treatment plan were analyzed. Results(1)Blood routine findings:Compared with MDS-RS patients,HGB and HCT levels were higher in MDS-MLD patients. WBC,ANC,M#,HGB,HCT were higher in extremely low risk group and low risk group than in high risk group and extremely high risk group.(2)Clinical characteristics of patients with different TCM syndromes:The ANC level and the percentage of ASXL1 gene mutation of patients with deficiency of qi and Yin was higher than that of patients with deficiency of spleen and kidney.(3)Outpatient treatment plan:The most frequently used Chinese medicines were Huangqi(Astragali Radix),Danggui(Angelicae Sinensis Radix),Fuling(Poria),Baizhu(Atractylodis Macrocephalae Rhizoma),Taizishen(Pseudostellariae Radix),Roucongrong(Cistanches Herba),Xianhecao(Agrimoniae Herba),Gouqizi(Lycii Fructus),Shengdihuang(Rehmanniae Radix). The network diagram showed that Huangqi(Astragali Radix),Danggui(Angelicae Sinensis Radix),Fuling(Poria),Taizishen(Pseudostellariae Radix)were closely related. Androgen was the most common combination therapy [95 cases(83.3%)],followed by Chinese patent medicine containing arsenic [78 cases(68.4%)]. Conclusion(1)HGB and HCT combined evaluation has certain clinical significance for the differentiation of MDS-RS and MDS-MLD. WBC,ANC,#M,HGB and HCT can help to determine the MDS patients with different prognostic characteristics of IPSS-R.(2)ANC ha

关 键 词：真实世界 骨髓增生异常综合征 中医证型 血常规 门诊治疗方案 

分 类 号：R259[医药卫生—中西医结合]