从“火血同病”论治弥漫大B细胞淋巴瘤嵌合抗原受体T细胞免疫疗法后血小板减少  

Treatment of post-CAR-T-induced thrombocytopenia in diffuse large B-cell lymphoma based on the concept of “fire and blood as one disease”

作　　者：杜笑丰 张雅月[1] 贠张君 刘铸 赵洪彬 侯丽[1] DU Xiaofeng;ZHANG Yayue;YUN Zhangjun;LIU Zhu;ZHAO Hongbin;HOU Li(Department of Oncology and Hematology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700)

机构地区：[1]北京中医药大学东直门医院血液肿瘤科,北京100700

出　　处：《现代中医临床》2025年第2期51-55,共5页Modern Chinese Clinical Medicine

基　　金：中央高水平中医医院临床科研业务费资助(No.CZ015);中华中医药学会青年求实项目(No.2023-QNQS-05);国家中医药管理局高水平中医药重点学科建设项目(No.zyyzdxk-2023268)。

摘　　要：弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma, DLBCL)是目前全世界发病率最高的非霍奇金淋巴瘤。嵌合抗原受体T细胞免疫疗法(chimeric antigen receptor T-cell immunotherapy, CAR-T)将基因修饰技术后的T细胞大量扩增并回输给患者,其类似中医外感六淫中的“火邪”。血小板减少是该疗法引起的发生率较高的血液系统不良反应之一。唐宗海认为“血与火原一家”“治火即是治血”。《景岳全书》将引起出血的病机概括为“火盛”和“气伤”两方面,“血动之由,惟火惟气耳”。于外火盛动血,于内五脏功能紊乱以脾脏功能失调为核心,故治疗血小板减少相关症状初期应清心肝二火;中期补脾血、滋脾阴;后期金水相生,兼顾肺肾。结合临床验案从“火血同病”论治DLBCL CAR-T后血小板减少进行阐述。Diffuse large B-cell lymphoma(DLBCL) is currently the most common non-Hodgkin lymphoma worldwide. Chimeric antigen receptor T-cell immunotherapy(CAR-T) involves the genetic modification and massive expansion of T cells, which are then re-infused into the patient. This therapy can be likened to the “fire pathogen” in Traditional Chinese Medicine(TCM), caused by external influences such as the six evils. Thrombocytopenia is one of the most common hematologic adverse reactions associated with this therapy. According to Tang Zonghai, “blood and fire are one family” and “treating fire is treating blood”. In Jingyue Quanshu(The Complete Works of [Zhang] Jing-yue), the pathogenesis of bleeding is summarized as “excessive fire” and “qi injury”, where “blood movement is caused by fire and qi”. Externally, excessive fire agitates the blood, and internally, dysfunction in the five organs—especially the spleen—leads to stagnation of blood circulation. Therefore, in treating thrombocytopenia related to CAR-T therapy, the initial focus should be on clearing fire from the heart and liver;in the intermediate stage, tonifying the spleen and blood, and nourishing spleen yin;and in the later stage, balancing metal and water while also addressing the lung and kidney. This article discusses the treatment of thrombocytopenia after CAR-T therapy for DLBCL based on the “fire and blood as one disease” concept and presents clinical case studies.

关 键 词：嵌合抗原受体T细胞免疫疗法 火血同病 弥漫大B细胞淋巴瘤 血小板减少 

分 类 号：R259[医药卫生—中西医结合]