含砷中药复方青黄散治疗骨髓增生异常综合征

含砷中药复方青黄散治疗骨髓增生异样综合征 含砷中药复方青黄散治疗骨髓增生异样综合征 临床平安有效的方法探讨 邓中阳1 ，方苏 1 ，王洪志 1 ，郭小青 1 ，杨秀鹏 1 ，麻柔 1 ，许勇钢 1 ， 杨晓红1 ，赵攀 1 ，王明镜 1 ，伊博文 1 ，尚晓泓 1 ，胡晓梅 1 1 中国中医科学院西苑医院 基金项目 北京市科委重点项目（Z141100006014003） 通信作者 胡晓梅，Email huxiaomei_2163 摘要 目的 建立含砷中药复方青黄散治疗骨髓增生异样综合征（MDS）的临床平安应用方法。 方法 1. 入组患者 200 例，赐予复方青黄散治疗，治疗 1 个月时，测定血砷浓度，将血砷浓度＜20 g/L 的患者随机分为比照组和试验组，比照组维持雄黄剂量不变，试验组增加雄黄剂量，至血砷浓度20 g/L，比较两组的血砷浓度、临床疗效以及平安性。 结果 与比照组相比，试验组治疗后血砷浓度显著提高（P＜0.05），血液学进步率显著上升（P＜0.05），血细胞计数均显著上升（P＜0.05），消化道不良反应无显著差异（P0.05）。 结论 依据血砷浓度调整雄黄剂量，提高有效血砷浓度，可提高疗效，而不增加临床毒副反应，是复方青黄散治疗 MDS 平安有效的临床应用方法。 【关键词】骨髓增生异样综合征；雄黄；砷；疗效；平安性 Study on the Safe and Effective Clinical s of Arsenic-containing Compound-Qinghuang Powder in the Treatment of Myelodysplastic Syndrome Deng Zhongyang, Fang Su, Wang Hongzhi, Guo Xiaoqing, Yang Xiupeng, Ma Rou, Xu Yonggang, Yang Xiaohong, Zhao Pan, Wang Mingjing, Yi Bowen, Shang Xiaohong, HuXiaomei Xiyuan Hospital, China Academy of Chinese Medical Sciences,Beijing 100091 China Abstract Objective To establish the safe and effective clinical s of arsenic-containing compound-Qinghuang Powder compound-QHP in the treatment of myelodysplastic syndrome MDS. s 1. 200 patients with MDS were treated with compound-QHP, and the blood arsenic concentrations of patients were detected in patients after treatment for 1 month. The patients were randomly divided into control group and treatment group when the blood arsenic concentrations of them were less than 20 g/L. Daily dose of realgar was maintained in control group, while that was increased so that the blood arsenic concentrations to be more than 20g/L in treatment group. The blood arsenic concentration, clinical efficacy and safety between the two groups were compared. Results The average blood arsenic concentration of treatment group was significantly higher than those of control group P＜0.05. The rate of hematology improvement was significantly higher in treatment group than that in control group P＜0.05. The Hb, ANC, and PLT significantly increased in treatment group after treatment. There was no significant difference of incidence rate of adverse reaction observed between treatment group and control group P＞0.05. Conclusions Monitoring the blood arsenic concentration and adjusting the daily dose of realgar to increase the effective blood arsenic concentration, and then improving efficacy without increasing the clinical toxicity, is the safe and effective clinical s of arsenic-containing compound-QHP in the treatment of MDS. Keywords Myelodysplastic syndrome; Realgar; Arsenic；Efficacy；Safety 骨髓增生异样综合征（myelodysplastic syndromes, MDS）是一组起源于造血干/祖细胞的获得性克隆性疾病，以骨髓无效造血、长期的进行性难治性血细胞削减、高风险向急性白血病转化为特征 [1] 。 本病临床表现为面色苍白、乏力、活动后心悸、气短等症状，或兼有出血、发热、脾大等体征，中医病名定为髓毒劳 [2] ，其中髓代表病位，毒代表病性，劳代表病状。 青黄散由青黛和雄黄组成，其中雄黄辛温有毒，属于砷制剂。 我们的既往探讨表明，青黄散治疗髓毒劳（MDS）有效 [3] ，但同时也发觉，其疗效与体内血砷浓度有关，有效血砷浓度在 20 g/L 以上 [4] 。 部分患者服用青黄散后出现消化道不良反应，导致砷的汲取削减，血砷浓度不足，影响疗效。 复方青黄散在