从肝脾肾论诊治低危骨髓增生异常综合征  

Diagnosis and Treatment of Low-risk Myelodysplastic Syndromes from Liver,Spleen,and Kidney

作　　者：姚利娟[1] 吴冰[1] 唐旭东[2] YAO Lijuan;WU Bing;TANG Xudong(Suzhou Hospital of Traditional Chinese Medicine,Nanjing University of Chinese Medicine,Suzhou 215009,China;Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)

机构地区：[1]南京中医药大学附属苏州市中医医院,苏州215009 [2]中国中医科学院西苑医院,北京100091

出　　处：《世界中医药》2024年第19期2989-2992,共4页World Chinese Medicine

基　　金：国家自然科学基金项目(82074258,82274502);中国中医科学院科技创新工程重大攻关项目(CI2021A01701)。

摘　　要：骨髓增生异常综合征(MDS)是一组源于造血干细胞且具有异质性的髓系克隆性疾病,近年来低危MDS的治疗主要依靠成分输血支持、免疫抑制剂、免疫调节剂及去甲基化等。低危的MDS属于髓毒劳病范畴,病程相对较长,且尚处于正邪消长阶段,患者多以正虚为主,邪气尚不尤盛,治法多以扶正为主。病机特点可归纳为先天禀赋不足,后天耗伤脾胃,导致气血生化无源;或有毒药物损伤骨髓,致使精髓亏虚,精血化生无源;或久病成郁,肝气不舒,气滞血瘀,瘀血不去,新血不生。其发病与五脏相关,但与肝、脾、肾三脏密切相关。治以健脾补肾舒肝为主。Myelodysplastic syndromes(MDSs)are a group of hematopoietic stem cell-derived and heterogeneous myeloid clonal disorders.In recent years,the treatment of low-risk MDS primarily involves supportive therapies such as component blood transfusions,immunosuppressive agents,immunomodulators,and demethylating agents.Low-risk MDS is categorized within the broader spectrum of myelotoxic diseases,and the disease course is relatively long.It is considered to be in the stage of“positive and negative forces in flux”,where the imbalance of yin and yang is still in a phase of gradual development.Patients generally exhibit a condition of“healthy qi deficiency”,where the pathogenic qi has not yet fully developed.Treatment methods mainly focus on tonifying the body′s healthy qi.The pathological mechanisms of low-risk MDS can be summarized as follows.Innate deficiency and acquired damage to the spleen and stomach lead to an inability to generate sufficient qi and blood.Alternatively,toxic substances may damage the bone marrow and lead to marrow depletion,resulting in deficiency of essence and blood,and a lack of source for the generation of new blood.Chronic illness can lead to liver qi stagnation,where liver qi becomes constrained,causing qi stagnation and blood stasis,preventing the clearing of stagnated blood and inhibiting the generation of new blood.The pathogenesis is related to five organs,but closely to the liver,spleen,and kidney,and treatment should primarily focus on invigorating the spleen,tonifying the kidneys,and soothing the liver.

关 键 词：脾气虚弱 肾精不足 肝郁气滞 培土以利中焦 滋水以固下焦 涵木以申上焦 危险分层 骨髓增生异常综合征 

分 类 号：R241[医药卫生—中医诊断学] R242[医药卫生—中医临床基础]