摘要
目的探讨加味炙甘草汤对急性髓系白血病(AML)患者常规方案化疗后骨髓抑制恢复及T淋巴细胞亚群分析的影响。方法选择2018年1月—2021年5月本院收治的辨证属于气阴两亏、津血不足证的AML患者43例作为研究对象,按随机数表法分为观察组(22例)和对照组(21例)两组。观察组采用地西他滨联合IAG方案化疗,同时口服中药汤剂加味炙甘草汤治疗,持续口服4周。对照组采用地西他滨联合IAG方案化疗,4周为一个周期。比较两组患者治疗前后血常规数值[血红蛋白(Hb)、白细胞(WBC)、中性粒细胞(NE)、血小板(PLT)]、T淋巴细胞亚群分析(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))及中医证候单项积分及总积分。结果治疗4周后,观察组血红蛋白、白细胞、血小板恢复时间与对照组相比,均有所缩短,差异具有统计学意义(P<0.05),观察组的Ⅲ度、Ⅳ度骨髓抑制时间亦较对照组有所缩短(P<0.05)。两组治疗4周后CD4^(+)、CD4^(+)/CD8^(+)均有所升高,且观察组高于对照组(P<0.05);两组CD8^(+)有所下降,且观察组低于对照组(P<0.05)。两组患者治疗4周后主症面色萎黄、形体消瘦、动则心慌气短、大便干结症状积分及次症脘闷不舒、口燥咽干、舌质淡红脉沉弱积分均有所下降;在单项积分方面,观察组在面色萎黄、心慌气短、脘闷不舒、口燥咽干积分低于对照组(P<0.05);且在总积分方面,观察组低于对照组(P<0.05)。两组患者不良反应的发生率相比,统计化疗后感染、心律失常、出血、肝功能损害差异均无统计学意义(P>0.05)。结论加味炙甘草汤辅助治疗可缩短AML患者化疗后血常规恢复时间,降低骨髓抑制严重程度,更好地改善患者T淋巴细胞水平,有效降低了中医证候积分,特别是改善了面色萎黄、心慌气短、脘闷不舒、口燥咽干单项积分和总积分,临床常见不良反应发生率无增加,有利于患者更好继续下一疗程化疗,值得推广。
Objective To investigate the effect of modified Zhigancao decoction on the recovery of bone marrow suppression and T cell subsets in patients with acute myeloid leukemia(AML)after chemotherapy.Methods 43 AML patients with syndrome deficiencyof qi and yin,deficiencyof fluid and blood those admittedto our hospital from January 2018 to May 2021 were included as the research objects.They were randomly divided into the observation group(22 cases)and control group(21 cases)according to random number table method.Patients in the observation group were treated with decitabine combined with IAG regimen,and they were treated with modified zhigancao decoction additionally for 4 weeks.The patients in the control group were treated with decitabine combined with IAG regimen for 4 weeks.The hemocytology parameters[hemoglobin(Hb),white blood cell(WBC),neutrophil(NE),platelet(PLT)],T lymphocyte subsets analysis(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),single score and total score of traditional Chinese medicine syndrome were compared between the two groups before and after treatment.Results After 4 weeks of treatment,the recovery time of hemoglobin,leukocyte and platelet in the observation group were shorter than those in the control group(P<0.05),and the time of gradeⅢandⅣbone marrow suppression was significantly shorter than those in the control group(P<0.05).After 4 weeks of treatment,CD4^(+) and CD4^(+)/CD8^(+) in both two groups were increased and those in the observation group were higher than those in the control group(P<0.05);the concentrations of CD8^(+) were decreased in the two groups and that of the observation group was significantly lower than that in the control group(P<0.05).After 4 weeks of treatment,the scores of main symptoms of yellowish complexion,emaciation,palpitation and shortness of breath due to movement,dry stool symptom scores,and scores of the secondary symptoms of wan tightness,dry mouth and throat,light red tongue and weak pulse decreased.In terms of single scores,yellowish complexion,shortness of breath,Wan tightness and shortness of breath,dry mouth and throat scores in the observation group were lower than those in the control group(P<0.05).The total score of the observation group was lower than that of the control group(P<0.05).There were no significant difference in incidence of adverse reactions including infection,arrhythmia,bleeding,liver function damage between the two groups(P>0.05).Conclusions The adjuvant treatment of modified Zhigancao decoction could shorten the recovery time of peripheral blood picture of AML patients after chemotherapy,reduce the severity of bone marrow suppression,improve the level of T lymphocyte subsets,it effectively reduces the TCM syndrome score,especially improves the single score and total score of sallow complexion,palpitation and shortness of breath,epigastric discomfort,dry mouth and dry throat,and is conducive to the next course of chemotherapy,which is worthy of promotion.
作者
尤轶
缪文雄
孟咸中
杨剑
朱红青
You Yi;Miao Wenxiong;Meng Xianzhong;Yang Jian;Zhu Hongqing(Hematology department,Taizhou TCM hospital affiliated to Nanjing University of TCM,Taizhou,Jiangsu,225300,China)
出处
《齐齐哈尔医学院学报》
2021年第19期1666-1670,共5页
Journal of Qiqihar Medical University
关键词
炙甘草汤
急性髓系白血病
骨髓抑制
T细胞亚群
Acute myeloid leukemia
Modified zhigancao decoction
Bone marrow suppression
T cell subsets
