猪苓汤辨证治疗异基因造血干细胞移植后迟发型出血性膀胱炎  

Zhuling decoction in the treatment of delayed hemorrhagic cystitis after allogeneic hematopoietic stem cell transplantation

作　　者：田莉 王慧睿[3,4] 李波 赵艳艳[4] TIAN Li;WANG Huirui;LI Bo;ZHAO Yanyan

机构地区：[1]河南中医药大学第一附属医院,河南郑州450046 [2]河南中医药大学,河南郑州450046 [3]郑州大学附属洛阳市中心医院,河南洛阳4710004 [4]河南科技大学第二附属医院,河南洛阳471000

出　　处：《中医临床研究》2024年第36期19-23,共5页Clinical Journal Of Chinese Medicine

基　　金：河南省中医药文化与管理研究项目重点课题(TCM2021004)。

摘　　要：异基因造血干细胞移植(Allogeneic Hematopoietic Stem Cell Transplantation,allo-HSCT)术后患者常合并发生出血性膀胱炎(Hemorrhagic Cystitis,HC),临床以膀胱广泛性出血、血尿等为主要表现,严重者出现尿路梗阻、大出血等表现,严重威胁患者的生命健康。早期识别和积极干预在HC患者的临床诊疗中至关重要,然而西医对本病的治疗尚无特效方案,临床常以充分水化、碱化尿液及利尿剂和美司钠的应用作为预防措施;免疫治疗、抗病毒治疗、膀胱冲洗等作为治疗手段。根据HC的临床表现,在中医中可归属于“尿血”“血淋”等范畴,中医治疗淋证经验丰富,疗效甚佳,无明显不良反应,可为HC的预防和治疗提供思路和方法。猪苓汤具有利水、清热、养阴的功效,现代临床中常用猪苓汤治疗多种泌尿系统疾病。本研究依据相关文献资料和临证经验,重点探讨了造血干细胞移植后HC的病因病机、治则治法。HC分为早发型和迟发型两种,早发型HC的发生以感受外邪为主,病性属实,热毒、湿热蕴结下焦;迟发型HC以阴虚内热为本,湿热之邪侵袭机体为标。以中药汤剂猪苓汤加减滋阴清热利尿,兼顾具体辨证,对2例allo-HSCT后合并发生HC患者的诊疗进行探索,均取得了良好的效果,现将经验总结如下。Postoperative patients of allogeneic hemato-poietic stem cell transplantation(allo-HSCT)are usually complicated with hemorrhagic cystitis(HC)after hemorrhagic cystitis.The main clinical manifestations are extensive hemorrhage of bladder and hematuria.In severe cases,urinary tract obstruction and massive hemorrhage occur,which seriously threaten the life and health of patients.Early identification and active intervention are crucial in the clinical diagnosis and treatment of patients with hemorrhagic cystitis,however,there is no effective solution for the treatment of this disease in Western medicine,and the clinical application of adequate hydration,alkalinization of urine and diuretics and sodium mesylate is often used as a preventive measure;the treatment mainly includes supportive therapy,immunotherapy,antiviral therapy,bladder irrigation and so on.According to the clinical manifestations of hemorrhagic cystitis,it can be attributed to the categories of“blood in the urine”and“hemorrhagic gonorrhea”in traditional Chinese medicine(TCM).TCM has rich experience in treating gonorrhea,with excellent therapeutic effect,and no obvious adverse reactions and side effects,which can provide ideas and methods for the prevention and treatment of hemorrhagic cystitis.Zhuling decoction(猪苓汤)has the effect of removing water,clearing heat and nourishing Yin.It is commonly used to treat many kinds of urinary system diseases in modern clinic.In view of this,based on the relevant literature and clinical experience,the author explores the etiology,pathogenesis and treatment of hemorrhagic cystitis after hematopoietic stem cell transplantation.Hemorrhagic cystitis can be divided into two types:early type and late type.The occurrence of early type hemorrhagic cystitis is mainly caused by exogenous pathogenic factors,the disease is excess in property,and heat toxicity and damp-heat accumulates in lower jiao.The root of late type hemorrhagic cystitis is characterized by Yin(阴)deficiency and internal heat,and the symptoms

关 键 词：猪苓汤 异基因造血干细胞移植 出血性膀胱炎 

分 类 号：R694.3[医药卫生—泌尿科学]