医学毕业论文再生方治疗骨髓增生异常综合征的临床疗效及细胞形态学观察

XX大学 毕业论文 再生方治疗骨髓增生异常综合征的临床疗效及细胞形态学观 察 姓 名 2014年6月25日 再生方治疗骨髓增生异常综合征的临床疗效及细胞形态学观察 作者刘清池 吴维海 冯新旺武大勇李刚荣 梁春耕 李建英 邢 江涛 【摘要】 目的观察中药再生方治疗骨髓增生异常综合征MDS- 难治性贫血、伴多系病态造血的难治性贫血的临床疗效及细胞形态学变化。方 法MDS患者共65例，随机分为再生方组32例和司坦哇醇组33例。再生方组 给予补肾中药再生方治疗，水煎服，日1剂;司坦哇醇组采用西药司坦哇醇，每 日68mg 口服。2组均治疗3个月以上进行疗效统计，并观察骨髓细胞形态学 变化。结果 再生方组基本缓解9例，部分缓解6例，进步10例，无效7例， 总有效率78.1;司坦哇醇组基本缓解1例，部分缓解3例，进步6例，无效20 例，总有效率30.3o再生方组总有效率显著高于司坦哇醇组PO.Olo细胞形 态学观察发现，再生方组使MDS红系病态造血减轻，对粒系、巨核系细胞形态 无明显影响;司坦哇醇组红系、粒系和巨核系细胞病态造血无改善。结论中药 再生方治疗MDS疗效好，可改善MDS患者红系的病态造血。 【关键词】骨髓增生异常综合征细胞形态学 [Abstract ] Objective To study the clinical effect of Chinese herbs Zaishengfang on myelodysplastic syndrome-re-fractory anemia RA and Refractory cytopenia with multilineage dysplasia R and observe the morphological changes after treatment.s 65patients withMDS 10RA and55R were divided into two groups randomlyZaisheng-fang group n32 and control group n33 .Patients in Zaishengfang group treated by a dose of Chinese herbs ad-ministered orally every day , and patients in control group treated by Androstanazole, 2mg, tid.The therapeutic course was three months in both groups.Morphological change of bone marrow smears was observed.The adverse events were recorded and reckoned transfusion of blood cell.Results The effective rate in Zaishengfang group was higher than that in the control group 78.1vs.30.3, P0.01 .In the Zaishengfang group, 9were relieved, 6were markedly improved, 10were improved, and7were ineffective.In the control group 1 were relived, 3were markedly improved, 6were improved, and20were ineffective.The count of transfusion of blood cell were fewer in the Zaishengfang group than in the control group, espe-cially in transfusion of platelets P0.01 .In adverse events Zaishengfang group were few and mild than the control group P0.01 .To observe the morphological of bone marrow smears find that the displasis of erythrocytic series were abated in the Zaishengfang group, but on change on granulocyte and megakaryocyte.No morphological changes of erythro-cyte and granulocyte and megakaryocyte in the patients of treatmentwith androstanazole.Conclusion Chinese herbs Zaish-engfang was effective and safe for MDS, and it can abate the displasis of erythrocytic series. [Key words ] myelodysplastic syndrome;Chinese herbs.therapeutic use clinical effect morphology 骨髓增生异常综合征myelodysplasitic syndromes, MDS是一组造血干 细胞恶性克隆性疾病，其基本特征是病态造血和无效血细胞形成。MDS具有一 些共同的临床和血液学表现[13],包括①主要发生于老龄人群;②外周血中 一系或多系血细胞减少，常有全血细胞减少;③骨髓中造血细胞数量正常或增多， 且有明确的病态造血的形态学改变;④患者常死于顽固性严重血细胞减少所引起 的并发症;⑤转化为急性髓系白血病的危险性明显增高。MDS各型中难治性贫血 RA及难治性贫血伴环状铁粒幼细胞增多RAS、伴有多系病态造血的难治 性贫血R,多属低中危MDS [4]。由于RA和RAS、R主要表 现为贫血，临床常按再生障碍性贫血治疗，国内多采用雄激素治疗，但疗效欠佳。 2004-072005-02,我院采用补肾中药再生方治疗低中危MDS32例，并与采用 司坦哇醇治疗33例进行对照，观察其临床疗效及对骨髓细胞形态的影响，现 报告如下。 1资料与方法 1.1 一般资料中低危MDS65例均为本院血液科住院患者，按世界卫生组 织（WHO）标准诊断和分型[1],其中RA10例，R55例;男39例，女 26例。按数字表法随机分为再生方组32例和司坦哇醇组33例，2组一般资料比 较见表1。表12组一般资料比较 1.2治疗方法 1.2.1治疗组予补肾中药再生方。药物组成人参、黄芷、淫羊蕾、补骨脂、 黄精、熟地黄、枸杞子、肉女蓉、鸡血藤