益气养阴方逆转难治性急性白血病多药耐药临床观察

Clinical observation of replenishing qi and nourishing yin formula reversing multidrug resistance of patients with refractory acute leukemia

目的观察益气养阴方逆转难治性急性白血病(RAL)多药耐药的疗效及对骨髓细胞周期的影响。方法将60例RAL患者随机分为治疗组30例,益气养阴方联合常规化疗、对照组30例,单用常规化疗。2组均治疗30d。观察各组治疗前后外周血象、骨髓缓解率、骨髓细胞周期比例、中医证候有效率及不良反应。结果治疗后骨髓原始细胞(原始+幼稚)比例、白细胞计数(WBC)较治疗前显著下降,且治疗组优于对照组(P<0.05);治疗组骨髓缓解率为60.00%(18/30),对照组骨髓缓解率为30.00%(9/30),2组比较差异显著(P<0.05);治疗后,治疗组骨髓细胞G0/G1期比例较对照组降低,S期、G2/M期较对照组升高(P<0.05);治疗组中医证候有效率为90.00%(27/30),明显高于对照组的33.33%(10/30)(P<0.05)。2组不良反应均以骨髓抑制、脱发、消化道反应为主,但治疗组发生率低于对照组。结论益气养阴方联合化疗治疗RAL的临床疗效优于单用常规化疗,且不良反应少,可能与益气养阴方可诱导白血病细胞进入细胞周期,增加化疗敏感性有关。

Objective To observe the effect of replenishing qi and nourishing yin formula on reversing the multidrug resistance and the bone marrow cell cycle of patients with refractory acute leukemia （RAL）. Methods Altogether 60 RAL patients were randomly divided into control group and treatment group （n = 30 each）. Control group was treated with conventional chemotherapy only, and treatment group was treated with conventional chemotherapy combined with replenishing qi and nourishing yin formula for 30 d Peripheral hemogram, the bone marrow remission rate, the bone marrow cell cycle rate, TCM syndrome score and side effects were calculated before and after the treatment in both groups. Results After treatment, proportion of primitive bone marrow cells （original cells and juvenile cells） and white blood cell count decreased significantly compared with before treatment in both groups （ P 〈 0.05 ） , and those of the treatment group decreased dramatically compared with control group （ P 〈 0.05 ）. Bone marrow remission rate in treatment group with 60.00% （18/30） increased significantly compared with control group with 30.00% （9/30） （P 〈0.05）. After treatment, the ratio of bone marrow cells in GO/G1 phase was lower and the ratio of cells in S phase and G2/M phase was higher than control group （P 〈0.05）. TCM syndrome score in treatment group decreased compared with treatment group （ P 〈 0.05 ）. During the whole period treatment, the side-effects of myelosuppression, alopecia and gastrointestinal reactions appeared frequently, and the incidence in treatment group was lower than those in control group. Conclusion Replenishing qi and nourishing yin formula combined with conventional chemotherapy acquired better effectiveness with fewer side-effects, attributed to the inducing of leukemia cell into the cell cycle and increasing the chemosensitivity.