真实世界下补肾解毒化瘀法治疗较高危骨髓增生异常综合征的生存分析及预测指标探讨  

Survival analysis and prediction index of treating high-risk myelodysplastic syndrome by invigorating kidney and detoxifying blood stasis method in real world

作　　者：刘健 李芮 杨秀鹏[2] 王洪志[2] 许勇钢[2] 陈卓 王德秀 肖海燕[2] 唐旭东[2] 杨宇飞[2] LIU Jian;LI Rui;YANG Xiupeng;WANG Hongzhi;XU Yonggang;CHEN Zhuo;WANG Dexiu;XIAO Haiyan;TANG Xudong;YANG Yufei(Graduate School of Beijing University of Chinese Medicine,Beijing 100029,China;Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China)

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

出　　处：《中华中医药杂志》2025年第3期1105-1111,共7页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.82074258,No.82274502);第二批北京市研究型病房示范建设项目(No.BCRW202108);中国中医科学院科技创新工程重大攻关项目(No.CI2021A01701)。

摘　　要：目的:探索真实世界下较高危骨髓增生异常综合征(MDS)应用补肾解毒化瘀法治疗影响生存预后的相关因素,为较高危MDS患者进行更加个性化的风险评估及生存预测提供理论依据。方法:收集2017年9月一2022年9月于中国中医科学院西苑医院血液科病房就诊的162例较高危MDS患者的临床资料,对其一般资料、血常规参数、骨髓参数、染色体核型等临床指标进行生存及预后分析。结果:162例患者中位0S为12(3,56)个月,一、二、三年生存率分别为80.25%、56.79%、47.53%。将162例较高危MDS患者按照结局指标分为死亡组与生存组,两组年龄、血小板及染色体分组之间比较,差异有统计学意义(P<0.05)。染色体异常核型的发生率与年龄、性别、WHO分型、IPSS-R积分无明显相关性,而染色体核型异常能够显著增加较高危MDS患者转变为AML的风险(P<0.01)。按照年龄、治疗方案、是否进展为AML、染色体核型及基因突变数量分组并比较各组生存情况,组间生存差异均具有统计学意义(P<0.05)。结论:真实世界下应用以含砷中药复方为主的补肾解毒化瘀法治疗的较高危MDS,其中治疗获益的较高危MDS患者可以明显改善预后;总生存期>3年的临床特征为:年龄<70岁、含砷中药复方联合化疗、未转化为AML、染色体核型正常、基因突变数量<4个。Objective:To explore the related factors affecting the survival prognosis of patients with higher-risk myelodysplastic syndrome treated with invigorating kidney and detoxifying blood stasis method in the real world,and to provide theoretical basis for more personalized risk assessment and survival prediction for patients with higher-risk myelodysplastic syndrome.Methods:The clinical data of 162 patients with higher-risk MDS who were admitted to the Department of Hematology of Xiyuan Hospital,China Academy of Chinese Medical Sciences from September 2017 to September 2022 were collected.The general data,blood routine parameters,bone marrow parameters,chromosome karyotype and other clinical indicators were analyzed for survival and prognosis.Results:The median OS of 162 patients was 12(3,56)months,and the 1-,2-,and 3-year survival rates were 80.25%,56.79%,and 47.53%,respectively.According to the outcome indicators,162 patients with higherrisk MDS were divided into the death group and the survival group,and the differences in age,platelet and chromosome grouping between the two groups were statistically significant(P<0.05).The incidence of chromosomal abnormalities was not significantly correlated with age,gender,WHO classification,and IPSS-R score,but chromosomal abnormalities could increase the risk of AML in higher-risk MDS patients(P<0.01).The patients were grouped according to age,treatment regimen,progression to AML,chromosome karyotype and number of gene mutations,and the survival of each group was compared,and the survival differences between the groups were statistically significant(P<0.05).Conclusion:In the real world,the application of tonifying kidney,detoxifying and removing blood stasis based on arsenic-containing traditional Chinese medicine compound in the treatment of higher-risk MDS patients can significantly improve the prognosis of higher-risk MDS patients who have benefited from treatment.The clinical characteristics of overall survival>3 years are:age<70 years,arsenic-containing traditional Chin

关 键 词：真实世界 补肾解毒化瘀法 较高危骨髓增生异常综合征 生存分析 预测指标 

分 类 号：R259[医药卫生—中西医结合]