中西医结合分期论治30例重型再生障碍性贫血

Clinical Evaluation on Treatment Based on Differentiation of Phases in 30 Severe Aplastic Anemia Cases

报告30例重型再生障碍性贫血(SAA)采用分期论治的疗效。经24天～36个月治疗,有效率53.3%,死亡率20%。有效者治疗1年后,骨髓增生无显著变化(P>0.05),治疗2年后明显好转(P<0.01)。随访15例10～56个月,除2例复发外,其余血象均维持或上升为基本治愈或缓解。结果提示,分期论治对 SAA 是一种有效的治疗手段,泻肝滋阴法能控制急剧恶化的病势。SAA 的治疗需要长疗程。雄激素与中药合用有协同作用。

Thirty patients with severe aplastic anemia(SAA)were studied prospectively.The period of treatment was divided into three phases including the critical phase,the improving phase and the recovering phase.The SAA patients were treated with various TCM recipes and androgen according to the different phases.After treatment for 24 days to 36 months,16 of 30 patients were clinical hematologic responders(53.3%)in which 4 recovered (13.3%).9 had remission(30.0%)and 3 yielded marked improvement(10.0%).and 14 were nonresponders (46.7%)and 6 patients died(20.0%).A close relationship between therapeutical effects and duration was shown in this study.It was observed that the cellularity of bone marrow before the first visit and 1 yr after treatment were not significantly different and the improved hemopoiesis of bone marrow 2 yrs after treatment compared to that of first visit was significantly different(P<0.01).Long-term follow-up in 15 patients for 10～ 56 months,they have maintained and/or returned to recovery level of hematologic parameter except that two patients had a relapse.Recipe based on purging the Liver and nourishing the Yin(泻肝滋阴)principle could control the critical phase,and withdrawing drugs slowly on the recovery phase has been used for all cases. Androgen was synergistic in action in combining with above-mentioned TCM recipes.