含砷中药复方青黄散治疗骨髓增生异常综合征的克隆选择性与砷体内效应的相关性研究

Correlationship of Clonal Selection of Treatment with Arsenious Compound Formula Qinghuang Powder with in Vivo Effects of Arsenic in Patients with Myelodysplastic Syndrome

目的探讨含砷中药复方青黄散治疗骨髓增生异常综合征(MDS)的克隆选择性与砷体内效应的相关性。方法对接受口服青黄散(每日雄黄0.16 g)治疗的MDS患者40例(治疗组)进行疗效评价,分析MDS患者口服青黄散后血砷浓度和线粒体膜电位(△Ψm),并与未服用青黄散或其他砷制剂的MDS患者(未治疗组)以及正常人(健康对照组)进行比较。结果治疗组总有效率为75.0%(30/40)。伴随正常克隆与+8异常克隆患者的疗效明显好于其他异常克隆类型(P<0.05)。治疗组全血和血浆砷浓度均明显高于未治疗组及健康对照组(P<0.05)。治疗组有效患者的全血砷浓度明显高于治疗失败者(P<0.05)。治疗组全血砷浓度明显高于血浆砷浓度(P<0.05)。治疗组正常核型和+8患者与其他异常克隆患者的血砷浓度差异无统计学意义(P>0.05)。治疗组线粒体△Ψm与未治疗组比较差异无统计学意义(P>0.05)。治疗组线粒体△Ψm与全血砷浓度没有相关性(P>0.05)。结论口服青黄散治疗MDS,砷被人体少量吸收,并进入细胞内发挥作用。MDS患者对青黄散的治疗反应与全血砷浓度具有相关性。青黄散治疗MDS的克隆选择性与全血砷浓度以及线粒体△Ψm变化没有相关性。

Objective To investigate the associations of clonal selection of treatment with arsenious compound formula Qinghuang Powder（QHP） with in vivo effects of arsenic in patients with myelodysplastic syndrome（MDS）.Methods The therapeutic effect of QHP（containing red orpiment,0.16 g daily） was evaluated in 40 patients with MDS（treatment group）.The blood concentration of arsenic and mitochondrial membrane potentials（△Ψm） were analyzed in treatment group,and compared with those in MDS patients treated without QHP or other arsenic compound（untreated group） and normal subjects（healthy group）.Results The total effective rate of the treatment group was 75.0%（30/40）.The efficacy in patients with normal clone or ＋8 abnormal clone was significantly better than that with other abnormal clone（P 0.05）.The blood and plasma concentrations of arsenic in the treatment group were significantly higher than those in the untreated group（P 0.05） and in the healthy group（P 0.05）.The blood arsenic concentration in patients with effectiveness was higher than those with treatment failure（P 0.05）.The arsenic concentration of blood was higher than that of plasma in treatment group（P 0.05）.No significant difference of blood arsenic concentrations was found between patients with normal or ＋8 alone and patients with other abnormal clones in treatment group（P 0.05）.Mitochondrial △Ψm of patients didn’t significantly change in treatment group compared with those in untreated group（P 0.05）.Mitochondrial △Ψm was not associated with blood arsenic concentration of patients in the treatment group（P0.05）.Conclusion Treated with QHP,low-level of arsenic was absorbed and play an intra-cellular role.The therapeutic effect of QHP in MDS patients is associated with blood arsenic concentration.The clonal selection of QHP was not associated with blood arsenic concentration and change of mitochondrial △Ψm.