含砷中药青黄散方案治疗超高龄伴TP53突变高危骨髓增生异常综合征1例并文献复习  

Arsenic-containing traditional Chinese medicine Qinghuang Powder protocol in the treatment of elderly high-risk myelodysplastic syndrome accompanied by TP53 mutation:a case report and literature review

作　　者：郭秋月 高文欣 陈卓 王德秀 周庆兵[2] 刘驰[1] 李柳[1] GUO Qiuyue;GAO Wenxin;CHEN Zhuo;WANG Dexiu;ZHOU Qingbing;LIU Chi;LI Liu(Department of Hematology,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing100091,China;Department of Geriatrics,Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing100091,China)

机构地区：[1]中国中医科学院西苑医院血液科,北京100091 [2]中国中医科学院西苑医院老年病科,北京100091

出　　处：《中国医药导报》2024年第19期183-187,共5页China Medical Herald

基　　金：中国中医科学院科技创新工程课题(CI2021A01705)。

摘　　要：骨髓增生异常综合征(MDS)是起源于造血干细胞的克隆性、髓系肿瘤性疾病,其伴原始细胞增多亚型及伴肿瘤蛋白53(TP53)基因突变均与高危疾病预后分层相关,其中TP53基因突变还与治疗耐药相关。高龄MDS患者的器官功能下降,合并症多,移植不可行,且多数不能耐受化疗、去甲基化药物治疗。患者为超高龄男性,确诊MDS伴原始细胞增多Ⅰ型,初诊时全血细胞进行性下降且需输血支持,修订版国际预后评分系统极高危,伴TP53基因突变。与同类患者比较,应用含砷中药青黄散方案治疗后中位生存期延长,血象三系有不同程度改善,生活质量提高,未发生治疗相关不良反应,耐受性良好,达到高龄MDS患者提高生活质量、延长生存期的治疗目标。本文回顾患者病历资料及应用含砷中药青黄散方案治疗过程,并结合国内外相关文献对高龄MDS的临床特点、治疗方法及相关基因突变特征进行分析,以期为高龄或超高龄预后不良MDS患者的治疗提供借鉴。Myelodysplastic syndrome(MDS)is a clonal,myeloid tumor disease originating from hematopoietic stem cells.Its associated subtypes of increased primordial cells and mutations in tumor protein 53(TP53)gene are associated with stratified prognosis in high-risk diseases.TP53 gene mutation is also associated with treatment resistance.Elderly MDS patients have decreased organ function,multiple comorbidities,infeasible transplantation,most cannot tolerate chemotherapy,and demethylated drug treatment.Patient is an extremely elderly male diagnosed with MDS accompanied by typeⅠincrease in primordial cells.At initial diagnosis,whole blood cells progressively decreased and blood transfusion support is required.Revised international prognostic scoring system is extremely high-risk,accompanied by TP53 gene mutation.Compared with similar patients,the use of arsenic-containing traditional Chinese medicine Qinghuang Powder protocol median survival period,improves blood count to varying degrees,improves quality of life,and does not cause treatment-related adverse reactions,with good tolerability,and achieves treatment goal of improving quality of life and prolonging survival for elderly MDS patients.This article reviews patient’s clinical data and treatment process using arsenic-containing traditional Chinese medicine Qinghuang Powder protocol,and analyzes clinical characteristics,treatment methods and related gene mutation characteristics of elderly MDS in combination with relevant domestic and foreign literature,so as to provide reference for the treatment of elderly or ultra elderly MDS patients with poor prognosis.

关 键 词：骨髓增生异常综合征 高龄 肿瘤蛋白53基因突变 含砷中药青黄散方案 

分 类 号：R551.3[医药卫生—血液循环系统疾病]