复方青黄散治疗骨髓增生异常综合征疗效分析

Compound Qinghuang powder in the treatment of patients with myelodysplastic syndromes

目的评价复方青黄散治疗骨髓增生异常综合征（myelodysPlasticsyndromes，MDS）的临床疗效。方法选择2013年3月-2014年5月中国中医科学院西苑医院门诊接受复方青黄散治疗的MDS患者61例，其中32例初始即接受复方青黄散治疗，29例曾经接受西药治疗3个月以上无效，其中14例停用西药1月之后接受复方青黄散治疗，另外15例在西药基础上联合复方青黄散治疗。3个月为1个疗程，均治疗2个疗程以上。治疗前及每个疗程结束时各检查1次全血细胞分析，评价临床疗效。结果61例MDS患者接受复方青黄散治疗2个疗程以上，总体疗效的总有效率为95．08％（58／61）。治疗后，MDS患者白细胞、血红蛋白、血小板均较治疗前升高，但血红蛋白升高明显[（78．02±29．19）gm比（91．16±34．60）g／L；t=2．267，P=0．025]。治疗前18例患者输血依赖，治疗后10例（55．56％）患者完全脱离输血，5例（27．78％）患者输血量明显减少。本研究中，29例MDS患者治疗2个疗程，血液学进步8例（27．59％）、稳定21例（72．41％）；32例治疗3个疗程，血液学进步17例（53．13％）、稳定12例（37．50％），治疗2个疗程与3个疗程的患者血液学进步率与稳定率比较，差异有统计学意义嘭值分别为4．102、6．128，P值分别为o．043、0．013）。与既往青黄散治疗MDS的研究数据比较发现，复方青黄散临床毒副反应降低〉20％，疗效提高〉20％，超过80％的患者获得红系反应。结论复方青黄散可提高MDS患者的临床疗效，降低毒副反应，显著减少患者输血量。

Objective To evaluate the effects of compound Qinghuang powder in the treatment of myelodysplastic syndromes （MDS）. Methods A total of 61 patients with MDS were collected. Out of 61 cases, 32were only treated with Qinghuang powder and 29 had ever been ineffectively treated with western medicine for more than 3 months. Out of the 29 cases, 14 had stopped using western medicine for 1 months and then were treated with compound Qinghuang powder, another 15 were treated with combination of compound Qinghuang powder and western medicine. The treatment time of 3 months was one course, and all the patients were treated for more than two courses. Blood cells were analyzed before and after treatment and clinical outcome was evaluated. Results 61 cases of MDS patients were treated with compound Qinghuang powder for more than two courses, the total effective rate was 95.08% （58/61）. After treatment, levels of white blood cells and hemoglobin were higher than that before treatment in patients with MDS, especially hemoglobin was significantly increased （78.02 ± 29.19 g/L vs. 91.16 ± 34.60 g/L; t=-2.267, P=0.025）. There were 18 patients depended on blood transfusion before treatment, while there were 10 cases （55.56%） without blood transfusion and5 cases （27.78%） with significant reduction of the amount of blood transfusion after treatment. Out of the 29 patients treated with 2 courses of compound Qinghuang powder, there were 8 cases （27.59%） with the improvement of the hematology and 21 cases （72.41%） with the stability of the hematology. Out of the32 patients treated with 3 courses of compound Qinghuang powder, there were 17 cases （53.13%） with the improvement of the hematology and 12 cases （37.5%） with the stability of the hematology. The differences of improvement and stability of the hematology between patients treated with 2 courses and 3 courses were statistically significant （χ2 values were 4.102 and 6.128, respectively; P values were 0.043 and 0.013, respectively）. It was found that the clinical adverse reaction decreased more than 20% and the efficacy increased more than 20% since more than 80% of the patients got hemoglobin response in patients treated with compound Qinghuang powder, as compared to the previously study on patients treated with Qinghuang powder. Conclusion Compound Qinghuang powder could enhance the efficacy, significantly decrease blood transfusion volume, and reduce the adverse reaction in the treatment of MDS.